Evaluation of carbohydrate counting knowledge among individuals with type 1 diabetes mellitus in Saudi Arabia: a cross-sectional study

Abstract

IntroductionCarbohydrate counting (CC) is an important nutritional strategy to improve glycaemic outcomes among patients with diabetes. Few studies have investigated CC knowledge among individuals with type 1 diabetes mellitus (T1DM) in Saudi Arabia. Therefore, we aimed to evaluate CC knowledge in Saudi adults with T1DM.Study design and methodsA cross-sectional study was conducted between December 2021 and February 2022, including 224 patients with T1DM from the University Diabetes Center, Riyadh. Adults aged ≥18 years, diagnosed with T1DM for >1 year, and residing in Saudi Arabia were included. CC knowledge was assessed using a previously well-studied tool (AdultCarbQuiz), which was translated into Arabic and tested for validity by a group of dieticians. Descriptive statistics were used for data analysis, and bivariate and regression analyses were conducted.ResultsThe AdultCarbQuiz questionnaire-Arabic version had good validity and reliability (Cronbach’s α: 0.87). The CC method was used by 54% of the participants. The mean CC knowledge score was 23.01±7.31. A significant negative linear relationship between the participants’ CC knowledge scores, and age and glycated haemoglobin (HbA1c) levels, was revealed by simple regression analysis. Furthermore, significant independent variables related to CC knowledge scores were CC use, HbA1c levels, being taught about CC (>5 times), insulin pump usage and DM duration (≤15 years).ConclusionsApproximately half of the patients used the CC method. The mean CC knowledge scores were better in patients who used the CC method, were more frequently taught about CC, were treated using an insulin pump, and had a shorter DM duration than their counterparts. Therefore, designing and implementing a well-structured nutrition education programme tailored to individuals with diabetes is crucial to provide them with up-to-date dietary information, as well as the necessary knowledge and skills, to improve their outcomes and manage their condition.

Value of carbohydrate counting

“…As Bawazeer et al 1 reported in this study among type 1 Saudi adults, dietitians and diabetes educators around the globe clearly have a primary role in the teaching of CC to patients with type 1 diabetes, but other members of the health care team are equally important to ensuring patient success implementing and accurately using CC in daily life. Only through effective collaboration among the health care team and patients, and routine reminders of CC concepts (ie, portion sizes) and other key lifestyle behaviours, will we be successful in mitigating the tidal wave of diabetes-related related premature mortality that IDF and others predict by 2040 2 23…”

“…Recently, Bawazeer et al reported on their study evaluating carbohydrate counting (CC) knowledge among adults with type 1 diabetes in Saudi Arabia (SA) 1. Anyone working with persons who have diabetes and use CC, and especially readers of BMJ Prevention, Nutrition and Health (BMJ NPH) will appreciate this study, as it highlights the value of this important tool for diabetes self-management education and support (DSMES), while also emphasising the need to understand the type 1 diabetes epidemic SA and many other countries are currently facing.…”

“…Bawazeer et al 1 found that those participants who scored higher on the AdultCarbQuiz had better glycaemic control, which mirrors findings reported by others among both youth and adults with type 1 diabetes 4 8–10. In this rather highly educated SA population, about half of the participants used CC and had acceptable mean knowledge scores, but those who scored highest were taught CC five or more times, illustrating the importance of burying the outdated concept of ‘one and done’ when it comes to DSMES.…”

“…The use of the effective health literacy-based teaching style, ‘teach-back’, promoted by the American Heart Association, the American Diabetes Association, Association of Diabetes Care and Education Specialists, American Nurses Association and other health care professions,18–20 was not reported by Bawazeer et al 1 ‘Teach-back’ is frequently used by nurses, but less so by dietitians and the international use of ‘teach-back’ among dietitians is even less well studied 20. A tool such as C-O-U-N-T C-A-R-B-S,21 developed for nurses and other non-dietitians, could be more widely adopted as a patient-centred, literacy-based approach to reinforcing CC concepts taught by dietitians.…”

The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review

“…Many physicians have found CC to be an effective educational tool for the management of children with diabetes [ 18 ]. Bawazeer et al presented encouraging findings from their investigation into the competency of CC knowledge among adults with T1DM in KSA [ 19 ]. Medical nutrition therapy guidelines suggest that individuals dealing with T1DM are advised to acquire knowledge of CC or other methods based on practical experience to enhance the management of BG levels [ 1 ].…”