Comparison between the continuous subcutaneous insulin infusion and multiple daily injection effect on dietary patterns among type 1 diabetic patients in Saudi Arabia

Abstract

Background: Type 1 diabetes mellitus (T1DM) care in children relies on insulin delivery and diet. Evidence on how delivery modality relates to meal-related behaviors in Saudi pediatric populations is limited. Objective: To compare dietary adherence patterns between continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) and examine associations with glycemic control (HbA1c). Design, Setting & Participants: Cross-sectional study conducted at pediatric diabetes clinics at three hospitals in the eastern region of Saudi Arabia between September 2023 and March 2024. N = 92 children/adolescents with T1DM. Methods: Dietary behaviors were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) (days/week; reverse scoring for high-sugar and high-fat items). Key behaviors included low-GI intake, fiber-rich starchy foods, and carbohydrate distribution. Group differences (CSII vs MDI) and associations with HbA1c < 7% were tested (χ²). Daily water intake (6–8 cups) was also examined in relation to HbA1c and insulin modality. Results: CSII was used by 40.2% and MDI by 59.8%. Dietary adherence did not differ by insulin modality (all p > 0.05). Greater intake of fiber-rich starchy foods was associated with HbA1c < 7% (χ² = 11.742, p < 0.05). Water intake was not associated with HbA1c (p > 0.05) but differed by modality (χ² = 7.246, p < 0.05). Conclusions: In this cohort of Saudi children and adolescents with T1DM, insulin modality was not associated with overall dietary adherence; however, fiber-forward starch choices were linked to improved glycemia. Pediatric care should emphasize skills-based nutrition education (carbohydrate distribution, lower-GI, fiber-rich starches) across modalities. The modality-related hydration difference warrants an adjusted, longitudinal evaluation.