PSUN200 Effect of carbohydrate counting education in children and adolescents with type I diabetes

Abstract

Background: The achievement and maintenance of normoglycemia is one of the most important goals to pre- vent both short and long-term complications in type 1 dia- betes mellitus (T1DM). As carbohydrate acts as the primary macronutrient affecting postprandial glycemic re- sponse, carbohydrate counting is crucial in adjusting pran- dial insulin doses to preserve postprandial blood glucose within normal limits. The purpose of this study is to evaluate the effect of carbohydrate counting education in children and adolescents with T1DM. Method: A retrospective chart review of 128 diagnosed T1DM patients who underwent carbohydrate counting edu- cation was conducted. All subjects were diagnosed with T1DM before December 2019, and were educated carbohy- drate counting before December 2020 in pediatric endocrin- ology, Severance Children’s Hospital, Seoul, Korea. We analyzed the data including clinical characteristics, educa- tion on carbohydrate counting, and glycated hemoglobin A1c (HbA1c) levels. 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 analyses, only the value of baseline HbA1c (P<0.001) as an indicator of DM management was significantly correlated with de- crease in HbA1c. Conclusions: In our study, carbohydrate counting edu- cation seems effective in glycemic control in patients with type 1 diabetes mellitus, but the decrease in HbA1c seems not enough. The effect of education differs according to the degree of glycemic management. For patients with poor management, providing proper education of carbohy- drate counting can make improvement in glycemic control. For well-managed patients, more advanced approach be- yond traditional education appears to be required. With proper education, better blood glucose control can be ex- pected to reduce complications and improve quality of life in T1DM patients.