Influence of the carbohydrate counting on auxological parameters and metabolic management in children and adolescents with type 1 diabetes

Abstract

Introduction: dietary therapy plays an important role in keeping good blood glucose level in patients with type 1 diabetes (T1D).  We evaluated the influence of carbohydrate counting  (CC) on auxological parameters and metabolic management in children and adolescents with T1D.

Methods and Materials: we enrolled all pediatric patients with T1DM followed up in our outpatient Pediatrics Diabetology Unit at IRCCS Policlinic San Matteo of Pavia, between June 2016 and June 2017. In all subjects the diagnosis was made or confirmed at least 6 months before this study started. All subjects were treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion with pump. Subjects were classified as “adherent” or “not adherent” to CC; auxological (weight, height, BMI score and BMI-z score) and metabolic parameters (glycated hemoglobin (HbA1c), insulin needs/24h, insulin to carbohydrates ratio (ICR), insulin-sensitivity factor (ISF)) were recorded

Results: Of all the patients enrolled (n=134; 75M/ 59F; mean age 12.6±5.1 years) diagnosed with T1DM, 21 (15.7%) were adherent to CC (16 of them were on pump insulin therapy, 5 on multiple injection insulin therapy). HbA1c was not statistically different in the two groups (p=0.46 and p=0.6, respectively). Patients adherent to CC tended to show higher BMIs (p=0.005) as well as BMI z-score (p=0.04) and overweight (p=0.03) than the non adherent group. the non adherent group showed lower ICR (p=0.04) and ISF (p=0.04), significantly related to the BMI (p<0.001).

Conclusion: CC represents a good alternative to the classic nutritional treatment in children and adolescents diagnosed with T1DM. Moreover, CC may influence weight and metabolic management, so it is necessary to be appropriately trained on the adequate dietary recommendations and the right counting method.