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

Diabetes Res Clin Pract. 2014 Mar;103(3):388-94. doi: 10.1016/j.diabres.2013.12.026. Epub 2014 Jan 3.

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.

Keywords: Bolus calculator; Carbohydrate counting; Childhood diabetes; Education; Insulin therapy; Type 1 diabetes.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Blood Glucose / metabolism
  • Case-Control Studies
  • Child
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Dietary Carbohydrates / administration & dosage
  • Dietary Carbohydrates / 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

Substances

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