ESPE Abstracts

Background: The achievement and maintenance of normoglycemia is one of the most important goals to prevent both short and long-term complications in type 1 diabetes mellitus (T1DM). As carbohydrate acts as the primary macronutrient affecting postprandial glycemic response, carbohydrate counting is crucial in adjusting prandial insulin doses to preserve postprandial blood glucose within normal limits. The purpose of this study is to examine the effect for carbohydrate counting education on glycemic management in patients with T1DM in South Korea and further discuss its important and future directions.

Method: A retrospective chart review of 128 diagnosed T1DM patients who underwent carbohydrate counting education was conducted. All subjects were diagnosed with T1DM before December 2019, and were educated carbohydrate counting before December 2020 in pediatric endocrinology, Severance Children’s Hospital, Seoul, Korea. We analyzed the effect of education on the basis of changes in HbA1c levels. In addition, the differences in educational effects according to various variables such as sex, age, diabetes duration, presence of complications, degree of disease control, and device use were identified.

Results: In 128 T1DM subjects educated, 48 (38%) were male. Their mean age at diagnosis was 8.6 ± 4.0 (years) and mean age at the time of education was 22.6 ± 7.8 (years). Overall, HbA1c levels at 3, 6, and 12 months after education showed a significant decrease compared to the baseline. The mean ±SD(standard deviation) HbA1c level, which was 8.8 ±1.9 (%) at the baseline, decreased to 8.3 ±1.7 at 3 months, 8.3 ±1.7 at 6 months, and 8.3 ±1.7 at 12 months after education. In multivariate linear regression analysis, only the value of baseline HbA1c (P<0.001) as an indicator of disease control was significantly correlated with decrease in HbA1c.

Conclusions: In our study, carbohydrate counting education seems effective in glycemic control in patients with type 1 diabetes mellitus, but the decrease in HbA1c seems not enough. The effect of education differed between poorly managed and well managed patients. For patients with poor management, providing proper education of carbohydrate counting, itself can make improvement in glycemic control. For well-managed patients, more advanced approach beyond traditional education appears to be required. With proper education, better blood glucose control can be expected to reduce complications and improve quality of life in T1DM patients.