ESPE Abstracts

Background: Carbohydrate counting is an essential part of comprehensive diabetes management and is required for children and adolescents with type 1 diabetes mellitus (T1DM), according to available guidelines. However, there is no specific evidence-grading for carbohydrate counting. This review was done to determine the effectiveness of carbohydrate counting in improving glycaemic control among children and adolescents with T1DM as measured by glycated haemoglobin (HbA1c).

Methods: We screened and reviewed randomised controlled trials conducted with at-least twelve months follow-up period that compared carbohydrate counting to assess prandial insulin dose with usual diabetes care. Quality assessment was guided by the Cochrane Collaboration’s Risk of Bias tool. HbA1c was extracted and compared at baseline, 12 months, and 24 months. Chi-squared test and I² statistics were done to assess heterogeneity. Homogenous results were pooled using the random-effects model.

Results: We identified six eligible studies of 493 potential records, comprising 1,043 children with T1DM. One of five studies showed strong evidence of HbA1c decrease after the 12 months of intervention compared to the baseline. There was no evidence of HbA1c reduction between baseline and 24 months among both the intervention and control groups. The mean difference of HbA1c between baseline, 12 months, and 24 months was too heterogeneous to pool. After 12 months of the follow-up period, there was strong evidence of lower HbA1c levels among participants who received education about carbohydrate counting and practising insulin dose adjustment throughout the trials than the control group who did not receive both interventions (mean difference=-0.24; 95%CI=-0.42 to -0.07; P=0.005) with no evidence of heterogeneity (P=0.72; I²=0%). The pooled estimate of HbA1c after 24 months suggested strong evidence of lower HbA1c among the carbohydrate counting group than control (mean difference=-0.46; 95%CI=-0.90 to -0.02; P=0.04), with weak evidence of heterogeneity (I²=58%; P=0.09).

Conclusion: Meta-analysis showed that education about carbohydrate counting and adjusting insulin dose based on carbohydrate quantification improved glycaemic control among children and adolescents with T1DM. More further higher-quality studies are necessary to evaluate the effectiveness of carbohydrate counting in improving glycaemic control.