The evaluation of the postprandial glucose response after breakfast in children and adolescents with type 1 diabetes

This PhD dissertation reflects three years of work in the field of breakfast among children and adolescents with type 1 diabetes (T1D). The main topic of this project is breakfast management in this population, as this specific meal has been identified as crucial to address to achieve optimal glycemic control, even in children using automated insulin delivery systems as treatment modality. This is especially true in Italy, where typical breakfast options are often high in sugars. This dissertation presents findings from two preliminary studies conducted with children with T1D who participated to a summer camp in June 2021 and June 2022. These studies aimed to assess the post-prandial glucose response after breakfast, comparing two distinct breakfast options with a typical isocaloric Italian breakfast: one modified to include an extra 20 g of fats, and another one with an additional 20 g of protein. These initial Þndings have been useful to highlight the unavoidable differences related to insulin treatment modalities in this population. Therefore, we have decided to evaluate the post prandial glucose response in children and adolescents with T1D with a standardized treatment modality, an automated insulin delivery system. The successful collaboration with the Children's and Young People's Diabetes Service at University College London Hospital enabled us to develop a study protocol to investigate the post-prandial glucose response after a typical breakfast in children with type 1 diabetes from Italy and the United Kingdom, using an automated insulin delivery system. This dissertation work concludes with the presentation of this multicenter study protocol.