ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes. 2018;19:1302–1308.

Diabetes education includes nutritional education and the provision of practical guidelines as to the interrelation between insulin requirements and carbohydrate intake. Carbohydrate (CHO) counting has therefore been a recommended daily practice to help patients to manage blood glucose levels in type 1 diabetes (T1D). Evidence suggests that CHO estimates should be within 10–15 g of the actual meal for optimal postprandial blood glucose control.

This study assessed the accuracy of CHO counting in adolescents with T1D. Adolescents (aged 12–18 years) with T1D who self-identified as regular CHO counters were recruited from the SickKids Diabetes Clinic, Toronto. Adolescents completed the PedsCarbQuiz (PCQ) and estimated CHO content of test trays (three meals and three snack trays) that were randomly assigned. Analyses were conducted to identify factors associated with accuracy of counting and CHO counting knowledge (PCQ score).

140 adolescents (78 females, mean age 14.7, S.D.=1.8) participated. The average PCQ score was 81±10%. 42% of adolescents accurately estimated meal trays (i.e. within 10 g of the actual CHO content), 44% estimated CHO inaccurately (within 10–20 g), while 14% were significantly inaccurate counters (>20 g variation). PCQ scores were higher in teens who CHO counted accurately than in those with significant inaccuracy, and a longer duration of diabetes correlated with a lower PCQ score.

Fewer than half of teens in this study were accurate CHO counters. It is disturbing to see that longer diabetes duration actually related to less accurate CHO counting. This points to a potential weaning off the educational efforts. It is assumed that in other socioeconomic and cultural environments adherence to CHO counting might even be lower. These results indicate the high need for regular clinical accuracy checks and reeducation.