Nutritional status, dietary intake, and nutrition-related interventions among older adults with type 1 diabetes: A systematic review and call for more evidence towards clinical guidelines

There is an emerging population of older adults (≥65 years) living with type 1 diabetes. Optimizing health through nutrition during this life stage is challenged by multiple and ongoing changes in diabetes, co-morbidities, and lifestyle factors. There is a need to understand nutritional status, dietary intake, and nutrition-related interventions that may maximize well-being throughout the lifespan in type 1 diabetes, in addition to nutrition recommendations from clinical guidelines and consensus reports.

Three reviewers used Cochrane guidelines to screen original research (January 1993 – 2023) and guidelines (2012 – 2023) in two databases (MEDLINE and CENTRAL) to characterize nutrition evidence in this population.

We found limited original research explicitly focused on nutrition and diet in adults ≥65 years of age with type 1 diabetes (6 experimental studies, 5 observational studies) and meta-analyses/reviews (n=1 scoping review),since the majority of analyses combined individuals ≥65 years with those ≥18 years with diverse diabetes durations, and also combined individuals with type 1 and type 2 diabetes. Further, existing clinical guidelines (n=10) lacked detail and evidence to guide clinical practice and self-management behaviors in this population.

From a scientific perspective, little is known about nutrition and diet among older adults with type 1 diabetes, including baseline nutrition status, dietary intake and eating behaviors, and the impact of nutrition interventions on key clinical and patient-oriented outcomes. This likely reflects the population’s recent emergence and unique considerations. Addressing these gaps is foundational to developing evidence-based nutrition practices and guidelines for older adults living with type 1 diabetes.