Asma Deeb1, Ahlam Al Hajeri1, Iman Alhmoudi1, Nico Nagelkerke2. 1. 1 Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates. 2. 2 Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates.
Abstract
BACKGROUND: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. METHODS: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals' CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician's counting were considered accurate. RESULTS: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals' CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman's rho = .019). CONCLUSION: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.
BACKGROUND:Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. METHODS:Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals' CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician's counting were considered accurate. RESULTS: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals' CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman's rho = .019). CONCLUSION: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.
Authors: Nancy F Sheard; Nathaniel G Clark; Janette C Brand-Miller; Marion J Franz; F Xavier Pi-Sunyer; Elizabeth Mayer-Davis; Karmeen Kulkarni; Patti Geil Journal: Diabetes Care Date: 2004-09 Impact factor: 19.112
Authors: T Danne; H B Mortensen; P Hougaard; H Lynggaard; H J Aanstoot; F Chiarelli; D Daneman; H Dorchy; P Garandeau; S A Greene; H Hoey; R W Holl; E A Kaprio; M Kocova; P Martul; N Matsuura; K J Robertson; E J Schoenle; O Søvik; P G Swift; R M Tsou; M Vanelli; J Aman Journal: Diabetes Care Date: 2001-08 Impact factor: 19.112
Authors: J Plank; G Köhler; I Rakovac; B M Semlitsch; K Horvath; G Bock; B Kraly; T R Pieber Journal: Diabetologia Date: 2004-07-17 Impact factor: 10.122
Authors: Rochelle L Ryan; Bruce R King; Donald G Anderson; John R Attia; Clare E Collins; Carmel E Smart Journal: Diabetes Care Date: 2008-05-05 Impact factor: 19.112
Authors: Melanie B Gillingham; Zoey Li; Roy W Beck; Peter Calhoun; Jessica Castle; Mark Clements; Eyal Dassau; Francis J Doyle; Robin L Gal; Peter Jacobs; Susana R Patton; Michael R Rickels; Michael Riddell; Corby K Martin Journal: Diabetes Technol Ther Date: 2020-09-29 Impact factor: 6.118
Authors: Mark Evans; Antonio Ceriello; Thomas Danne; Christophe De Block; J Hans DeVries; Marcus Lind; Chantal Mathieu; Kirsten Nørgaard; Eric Renard; Emma G Wilmot Journal: Diabetes Obes Metab Date: 2019-06-19 Impact factor: 6.577