Supervisors info:
Νικόλαος Τεντολούρης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Μακρυλάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος Κόκκινος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Aims: The concept of carbohydrate counting is not new. In the early 1990’s the Diabetes Control and Complications Trial (DCCT) used carbohydrate counting as one of its education tools who may fit the needs of patients who use multiple daily injections (MDI) or an insulin pump. Carbohydrate counting method allows patients with type 1 diabetes (T1D) to adjust mealtime insulin dose to meal carbohydrate intake. Patients are encouraged to count carbs using a variety of ways such as carb choices, grams, portion/serving, glycemic index, exchanges and carbohydrate/insulin ratio. Complete nutrition education on carbohydrate counting can make food planning flexible for patients and may have a positive effect on glycemic control, may reduce hypoglycemia events and improve quality of life. Little is known about the ability of adult patients with T1D to count carbohydrates. The aim of this study is to assess gaps in patients’ understanding of carbohydrate counting.
Methods: Data were collected from 42 individuals (50% women, 50% men) with T1D (mean age: 46,4 ± 15.9 years; duration of diabetes: 26 ± 13.9 years; HbA1c: 7.5 ± 1.2%) who were attended by the Diabetes Clinic at Tzaneio Hospital. We observed the ability of adults to accurately estimate carbohydrates by analyzing their response to the AdultCarbQuiz. The AdultCarbQuiz is a validated tool specifically focused on testing carbohydrate knowledge among adult patients with diabetes and is consisted of 43 items divided among the 5 domains as follows: carbohydrate food recognition (19 items), carbohydrate food content (7 items), nutrition label reading (4 items), glycemic targets (4 items), hypoglycemia prevention and treatment (5 items) and carbohydrate content of meals (4 items).
Results: A small proportion of participants (45,2%), reported being trained on carbohydrate counting the last 3 years. For those participants trained on carbohydrate counting, a positive correlation was observed between nutrition training and time in range (70-180 mg/dL) (p=0,05), and a negative correlation was observed between nutrition training and time spent in severe hypoglycemia (<54 mg/dL) (p=0,05). In addition, the mean score of correct answers for the AdultCarbQuiz was 29,07 ± 5,96. For those participants, who successfully responded to the questionnaire, a positive correlation was observed between the higher score of correct answers and CGM indicators such the increased time in range (70-180mg/dL) (p=0,04). In addition, it is evident that there is a positive correlation between the higher score of correct answers and nutrition education (p=0,008).
Conclusions: The present study showed that nutritional education and knowledge on carbohydrate counting is associated with better glycemic control and reduction of severe hypoglycemia, particularly important findings that may be need to be considered in clinical practice.
Keywords:
Nutritional education, Carbohydrate counting, Insulin to carbohydrate Ratio, Insulin sensitivity factor, Glycemic control
