Effects of advanced carbohydrate counting on glucose control and quality of life in children with type 1 diabetes

Abstract

Objective: The effect of advanced carbohydrate counting (ACC) on metabolic and quality of life (QOL) outcomes is uncertain in children with type 1 diabetes. Our aim was to determine whether ACC would improve HbA1c and QOL scores as compared with standard nutrition in this population. Methods: We randomized 87 patients using pump and rapid-acting analogs in a 1 year randomized multicenter study (age 9.6 ± 3.5 years, diabetes duration 4.6 ± 2.7 years, HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]). The ACC group received CC education and the control group received traditional dietary education. HbA1c was measured every 3 months. At 0 and 1 year, general, diabetes-specific, and dietrelated QOL were respectively assessed by the KIDSCREEN and WHO-5 questionnaires, the diabetes-specific module of the DISABKIDS, and the diet restriction items of the DSQOLS. Results: Mean HbA1c was lower in the ACC than the control group at 3 months (P < .05) and tended to be lower at 6 months (P = .10), 9 months (P = .10), but not at 12 months. The mean of individual average HbA1c during the one-year study period (from M3 to M12) was 7.63 ± 0.43 in the ACC vs 7.85 ± 0.47% in the control group (60 ± 5 vs 62 ± 5 mmol/mol)(P < .05). ACC was associated with significantly higher scores at 1 year on the KIDSCREEN children's psychological scale and the KIDSCREEN parents' physical scale, the DISABKIDS children's treatment scale, and the children's and parents' dietary restriction scales of the DSQOLS (indicating better QOL or lower perceived diet restriction). Conclusions: ACC may be associated with small improvements in metabolic control and QOL scores in children.

Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications

“…A recent study by Donzeau et al. examined carbohydrate counting versus fixed dose insulin for meals and found no change in BMI z-score in youth over one year of follow-up, though the fairly low starting mean BMI z-score (0.7 ± 0.8) of this population and possible selection bias may limit the generalizability of the findings ( 42 ).…”

Efficacy and safety of carbohydrate counting versus other forms of dietary advice in patients with type 1 diabetes mellitus: a systematic review and meta‐analysis of randomised clinical trials

“…Following the full-text article assessment, 20 studies were excluded, seven because both the intervention and comparator included carbohydrate counting, five were systematic reviews, three were nonrandomised clinical trials, two were single-arm clinical trials, one had no relevant outcomes, one was a partial report of another clinical trial, and one was a protocol of an ongoing clinical trial. Finally, 11 studies 18,[24][25][26][27][28][29][30][31][32][33] were included in the qualitative and quantitative synthesis (Figure 1).…”

“…Only one study was judged as having a low ROB, 32 six fell into the some concern category, 18,24,26,27,31,33 and four showed a high risk of bias. 25,[28][29][30] The more frequent concerns were related to bias in the randomisation process or missing outcome data.…”

“…QoL and satisfaction questionnaires: Several questionnaires and different ways of reporting QoL and treatment satisfaction were used in six studies, 24,26,27,29,32,33 so we decided that a qualitative synthesis was more appropriate to report this outcome.…”

“…Two studies used the Diabetes-Specific QoL Scale (DSQOLS) questionnaire. 27,33 One reported only the changes in the questionnaire's different domains with no significant difference among groups. 27 Donzeau et al 33 applied the DSQOLS to both the parents and the patients and found an improvement in QoL related to carbohydrate counting.…”