Impact of carbohydrate counting on glycemic control in children with type 1 diabetes

Sanjeev N Mehta, Nicolle Quinn, Lisa K Volkening, Lori M B Laffel, Sanjeev N Mehta, Nicolle Quinn, Lisa K Volkening, Lori M B Laffel

Abstract

Objective: To study the association between parent carbohydrate counting knowledge and glycemic control in youth with type 1 diabetes.

Research design and methods: We assessed 67 youth ages 4-12 years with type 1 diabetes (duration >or=1 year). Parents estimated carbohydrate content of children's meals in diet recalls. Ratios of parent estimates to computer analysis defined carbohydrate counting knowledge; the mean and SD of these ratios defined accuracy and precision, respectively. A1C defined glycemic control.

Results: Greater accuracy and precision were associated with lower A1C in bivariate analyses (P < 0.05). In a multivariate analysis (R(2)= 0.25, P = 0.007) adjusting for child age, sex, and type 1 diabetes duration, precision (P = 0.02) and more frequent blood glucose monitoring (P = 0.04), but not accuracy (P = 0.9), were associated with lower A1C. A1C was 0.8% lower (95% CI -0.1 to -1.4) among youth whose parents demonstrated precision.

Conclusions: Precision with carbohydrate counting and increased blood glucose monitoring were associated with lower A1C in children with type 1 diabetes.

Figures

Figure 1
Figure 1
Child A1C (mean ± SE) by quartiles of parent carbohydrate counting accuracy (A) or precision (B). A: The A1C of children whose parents overestimated carbohydrate content (Q4) was higher than the A1C of children whose parents were most accurate (Q2–3). The A1C of children whose parents underestimated carbohydrate content (Q1) was not significantly different from the A1C of other children. B: The A1C of children whose parents were the least precise (Q4) was significantly higher than the A1C of all other children (Q1–3).

References

    1. Anderson EJ, Richardson M, Castle G, Cercone S, Delahanty L, Lyon R, Mueller D, Snetselaar L: Nutrition interventions for intensive therapy in the Diabetes Control and Complications Trial: the DCCT Research Group. J Am Diet Assoc 1993; 93: 768– 772
    1. Delahanty LM, Halford BN: The role of diet behaviors in achieving improved glycemic control in intensively treated patients in the Diabetes Control and Complications Trial. Diabetes Care 1993; 16: 1453– 1458
    1. American Diabetes Association Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2007; 30( Suppl. 1): S48– S65
    1. Kawamura T: The importance of carbohydrate counting in the treatment of children with diabetes. Pediatr Diabetes 2007; 8( Suppl. 6): 57– 62
    1. Buzzard IM, Faucett CL, Jeffery RW, McBane L, McGovern P, Baxter JS, Shapiro AC, Blackburn GL, Chlebowski RT, Elashoff RM, Wynder EL: Monitoring dietary change in a low-fat diet intervention study: advantages of using 24-hour dietary recalls vs food records. J Am Diet Assoc 1996; 96: 574– 579
    1. Levine BS, Anderson BJ, Butler DA, Brackett J, Laffel L: Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. J Pediatr 2001; 139: 197– 203
    1. Haller MJ, Stalvey MS, Silverstein JH: Predictors of control of diabetes: monitoring may be the key. J Pediatr 2004; 144: 660– 661
    1. Klesges RC, Klesges LM, Brown G, Frank GC: Validation of the 24-hour dietary recall in preschool children. J Am Diet Assoc 1987; 87: 1383– 1385
    1. Stein AD, Shea S, Basch CE, Contento IR, Zybert P: Variability and tracking of nutrient intakes of preschool children based on multiple administrations of the 24-hour dietary recall. Am J Epidemiol 1991; 134: 1427– 1437
    1. Brand-Miller J, Hayne S, Petocz P, Colagiuri S: Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003; 26: 2261– 2267
    1. Burdick J, Chase HP, Slover RH, Knievel K, Scrimgeour L, Maniatis AK, Klingensmith GJ: Missed insulin meal boluses and elevated hemoglobin A1c levels in children receiving insulin pump therapy. Pediatrics 2004; 113: e221– e224
    1. Deeb LC, Holcombe JH, Brunelle R, Zalani S, Brink S, Jenner M, Kitson H, Perlman K, Spencer M: Insulin lispro lowers postprandial glucose in prepubertal children with diabetes. Pediatrics 2001; 108: 1175– 1179
    1. Boland E, Monsod T, Delucia M, Brandt CA, Fernando S, Tamborlane WV: Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care 2001; 24: 1858– 1862
    1. Heptulla RA, Allen HF, Gross TM, Reiter EO: Continuous glucose monitoring in children with type 1 diabetes: before and after insulin pump therapy. Pediatr Diabetes 2004; 5: 10– 15
    1. Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N: Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005; 28: 186– 212

Source: PubMed

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