Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: an 18-month observational study.

Abstract

AIMS:

This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections.

METHODS:

We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months.

RESULTS:

At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14 ± 0.41% at 6 months vs. 7.35 ± 0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95 ± 0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018).

CONCLUSIONS:

CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.

• Authors: Ivana Rabbone, Andrea E Scaramuzza, Maria Giovanna Ignaccolo, Davide Tinti, Sabrina Sicignano, Francesca Redaelli, Laura De Angelis, Alessandra Bosetti, Gian Vincenzo Zuccotti, Franco Cerutti
• Journal: Diabetes research and clinical practice (Diabetes Res Clin Pract) Vol. 103 Issue 3 Pg. 388-94 (Mar 2014) ISSN: 1872-8227 [Electronic] Ireland
• PMID: 24447811 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Blood Glucose
• Dietary Carbohydrates
• Glycated Hemoglobin A
• Insulin
• hemoglobin A1c protein, human

Topics

• Adolescent
• Blood Glucose (metabolism)
• Case-Control Studies
• Child
• Diabetes Mellitus, Type 1 (blood, drug therapy)
• Dietary Carbohydrates (administration & dosage, analysis)
• Female
• Follow-Up Studies
• Glycated Hemoglobin (analysis)
• Glycemic Index
• Humans
• Hyperglycemia (drug therapy)
• Hypoglycemia (drug therapy)
• Insulin (administration & dosage)
• Insulin Infusion Systems
• Male
• Prospective Studies