Simplifying carb counting: A randomized controlled study – Feasibility and efficacy of an individualized, simple, patient‐centred carb counting tool

Endocrinology, Diabetes & Metabolism · 8 authors, 3 centres

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TL;DR

Both methods improved A1C levels over 6 months, with SCC being non-inferior overall and more effective in participants aged 40 and older. A key limitation is the single-center design and the need for further studies to corroborate findings.

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This study tested a simple, individualized tool designed to overcome these barriers. Methods: In a randomized controlled trial at a single diabetes clinic, 85 adults with T1DM (A1C ≥8.5%) were assigned to either Regular Carbohydrate Counting (RCC, n=41) or a Simplified, individualized Carbohydrate Counting tool (SCC, n=44). Both groups received up to six dietitian-led instructional sessions over 6 months. The primary outcome was HbA1c at 6 months. Results: Both groups showed a significant overall improvement in mean A1C from baseline (9.9%) to follow-up (8.6%), with p=.001. The SCC tool was found to be non-inferior to RCC. Stratification by age revealed that among participants ≥40 years old, only the SCC group showed a statistically significant A1C improvement (from 9.6% to 8.6%, p=.002). Participants recently diagnosed with T1DM (<5 years) in both groups had greater A1C improvement (-6.1 vs. -0.7) than those with longer disease duration. Both groups reported reduced diabetes-related distress on the PAID5 questionnaire (10.6 to 9.5, p=.023), with a greater improvement noted in women. Limitations: The study was conducted at a single center with one dietitian and did not include pediatric patients, which may limit generalizability. Implications: The individualized SCC tool is a feasible, low-tech alternative that may be particularly beneficial for older adults with T1DM and could help reduce barriers to effective carbohydrate counting.

STUDY TYPE

RCT

SPECIALTY

endocrinology

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10000617

Simplifying carb counting: A randomized controlled study – Feasibility and efficacy of an individualized, simple, patient‐centred carb counting tool

Endocrinology, Diabetes & Metabolism

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ABSTRACT

Abstract Introduction The purpose of this study was to introduce and test a simple, individualized carbohydrate counting tool designed for persons with Type 1 Diabetes Mellitus (T1DM) in order to determine whether the tool improved A1C levels for participants with age, education or language barriers. Methods In a randomized controlled trial, 85 participants were offered six diabetes instructional sessions free of charge over a six‐month period. Forty‐one received guidance using the regular carbohydrate counting (RCC) method. Forty‐four received guidance using an individualized ‘Simple Carb Counting’ (SCC), involving two customized tables prepared for participants. Results The simple, individualized SCC tool for carbohydrate counting was non‐inferior to the standard method of RCC. The SCC tool was more effective among participants aged 40 and older, while no differences were found when comparing participants by education level. Irrespective of intervention group, all participants improved their A1C level (9.9% = 13.2 mmol/L vs 8.6% = 11.1 mmol/L, p = .001). A greater improvement in A1C level was seen in newly diagnosed participants (−6.1 vs −0.7, p = .005, −3.4 vs 0.9, p = .032) in both the RCC and SCC groups. All participants expressed improved emotional level per their PAID5 questionnaires (Problem Areas in Diabetes Scale‐PAID), (10.6 (±5.7) vs 9.5 (±5.7), p = .023), with women reporting greater improvement than men. Conclusions SCC is a simple, individualized, feasible, low‐tech tool for carbohydrate counting, which promotes and enables accurate insulin dosing in people with T1DM. It was found more effective among participants aged 40 and older. Additional studies are needed to corroborate these findings.

CITATION EXPORT

Shulamit Witkow, Idit F. Liberty, Irina Goloub et al.. Simplifying carb counting: A randomized controlled study – Feasibility and efficacy of an individualized, simple, patient‐centred carb counting tool. Endocrinology, Diabetes & Metabolism. (2023). https://doi.org/10.1002/edm2.411

AUTHORS

8 · 3 CENTRES

Shulamit Witkow, Idit F. Liberty, Irina Goloub, Malka Kaminsky, Olga Otto, YonesAbu Rabia, Ilana Harman Boehm, Rachel Golan

1 Diabetes Unit, Soroka University Medical Center Beer Sheva Israel
2 Ben‐Gurion University of the Negev Beer Sheva Israel
3 Clalit HMO of the Negev Beer Sheva Israel