The role of carbohydrate counting in type 1 diabetes

J Wylie-Rosett - The Lancet Diabetes & Endocrinology, 2014 - thelancet.com
J Wylie-Rosett
The Lancet Diabetes & Endocrinology, 2014thelancet.com
The goal of carbohydrate counting in the management of type 1 diabetes is to match insulin
dose to food intake to permit flexibility in food choices without adversely affecting metabolic
control and health outcomes. 1 In The Lancet Diabetes and Endocrinology, the meta-
analysis of carbohydrate counting research in type 1 diabetes by Kirstine Bell and
colleagues2 identified some evidence to recommend carbohydrate counting over alternate
advice or so-called usual care in adults with type 1 diabetes. Although the meta-analysis of …
The goal of carbohydrate counting in the management of type 1 diabetes is to match insulin dose to food intake to permit flexibility in food choices without adversely affecting metabolic control and health outcomes. 1 In The Lancet Diabetes and Endocrinology, the meta-analysis of carbohydrate counting research in type 1 diabetes by Kirstine Bell and colleagues2 identified some evidence to recommend carbohydrate counting over alternate advice or so-called usual care in adults with type 1 diabetes. Although the meta-analysis of the seven randomised trials that met the inclusion criteria identified no overall significant improvement in HbA1c concentration with carbohydrate counting versus control or usual care (–0ˇ 35%, p= 0ˇ 096), restricting the analysis to the five trials in adults, which used a parallel design, identified a–0ˇ 64% improvement in HbA1c in favour of carbohydrate counting (p< 0ˇ 001). The meta-analysis also identified a non-significant pattern for less common hypoglycaemia in patients using a carbohydrate counting intervention than those using the alternate approaches.
Carbohydrate counting, which was often used in intensifying treatment in the Diabetes Control and Complications Trial (DCCT), became a dominant feature of type 1 diabetes medical nutrition therapy (MNT) in the 1990s. 1 3, 4 However, although the DCCT provided evidence that lowering HbA1c with intensive therapy reduced microvascular complications, this study did not address the clinical efficacy of carbohydrate counting per se. 5 The later Dose Adjustments for Normal Eating (DAFNE) randomised controlled trial, which was included in the present meta-analysis, has provided the strongest evidence so far that carbohydrate counting can reduce HbA1c when combined with an algorithmic approach for insulin adjustment. 6 The DAFNE trial had a more intensive educational intervention (5 day course)
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