Effects of Carbohydrate Counting on Glucose Control and Quality of Life Over 24 Weeks in Adult Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion

Abstract

OBJECTIVEFew studies have assessed the efficacy of carbohydrate counting in type 1 diabetes, and none have validated its efficacy in patients who are treated with continuous subcutaneous insulin infusion (CSII). The aim of our study was to test the effect of carbohydrate counting on glycemic control and quality of life in adult patients with type 1 diabetes who are receiving CSII.RESEARCH DESIGN AND METHODSSixty-one adult patients with type 1 diabetes treated with CSII were randomly assigned to either learning carbohydrate counting (intervention) or estimating pre-meal insulin dose in the usual empirical way (control). At baseline and 12 and 24 weeks, we measured HbA1c, fasting plasma glucose, BMI, waist circumference, recorded daily insulin dose, and capillary glucose data, and administered the Diabetes-Specific Quality-of-Life Scale (DSQOLS) questionnaire.RESULTSIntention-to-treat analysis showed improvement of the DSQOLS score related to diet restrictions (week 24 – baseline difference, P = 0.008) and reduction of BMI (P = 0.003) and waist circumference (P = 0.002) in the intervention group compared with control subjects. No changes in HbA1c, fasting plasma glucose, daily insulin dose, and hypoglycemic episodes (<2.8 mmol/L) were observed. Per-protocol analysis, including only patients who continuously used carbohydrate counting and CSII during the study, confirmed improvement of the DSQOLS score and reduction of BMI and waist circumference, and showed a significant reduction of HbA1c (−0.35% vs. control subjects, P = 0.05).CONCLUSIONSAmong adult patients with type 1 diabetes treated with CSII, carbohydrate counting is safe and improves quality of life, reduces BMI and waist circumference, and, in per-protocol analysis, reduces HbA1c.

Optimizing a prandial insulin dosing in patients with type 1 diabetes

“…There is evidence that the therapy conducted in this way is safe, improves living comfort and may have a beneficial effect on anthropometric indicators such as BMI or waist circumference [17]. Although FIT is a common, accepted and apparently optimal method of therapy, meta-analyses of previous studies show only slight differences in the degree of diabetes control among patients who calculate the amount of carbohydrates and patients who administer fixed doses of prandial insulin [17][18][19]. Differences in HbA 1c in the FIT group in relation to the control group ranged from -0.35 to -0.64%, thus indicating the need to find new algorithms for calculating prandial insulin doses.…”

Modelling the effect of insulin on the disposal of meal-attributable glucose in type 1 diabetes

“…d/dt 7^ 0) at the onset of the experiment (t = 0). Furthermore, we investigated a mixed case in which the remote effect of insulin x(t) was assumed in steady-state (hence the initial condition from either (18) or (19) applied), whereas EM masses were not considered steady, thus being qJ EM , q® EM extra model parameters and Eq. (20) for initial conditions becoming not applicable.…”

“…Correspondingly, for the obtain: (18) ; 'cut-off' approach we would (19) Steady-state conditions for the masses of the EM tracer compartments can also be solved algebraically:…”

“…However, even experienced patients often estimate insulin amounts and/or timing inappropriately [2]. To alleviate this, management strategies beyond carbohydrate counting [18] and bolus calculators [31] require mechanistic knowledge about the absorption and disposal regimes of meal-attributable glucose.…”

Lifestyle Modifications in the Management of Type 1 Diabetes: Still Relevant After All These Years?

“…In addition, numerous studies have demonstrated that interventions such as MNT can help patients with T1D attain better diabetes control, although much more research is needed. 10,[16][17][18][19][20][21] There are many reasons for poor adherence to treatment recommendations for patient lifestyle education, including restrictions on reimbursement by medical insurance providers for MNT or diabetes self-management training (DSMT) sessions. There is also inadequate patient access to certified programs, especially outside of major urban areas.…”