Impact of Carbohydrate Counting on Glycemic Control in Children With Type 1 Diabetes

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 ≥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 (R²= 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.Medical nutrition therapy in type 1 diabetes is associated with improved glycemic outcomes (1,2). Meal-planning strategies for type 1 diabetes emphasize the relationship between prandial insulin dose selection and the anticipated amount of carbohydrate to be consumed. Although no method for carbohydrate estimation has proven superior in the management of youth with type 1 diabetes, carbohydrate counting has become a principal strategy for children with type 1 diabetes (3,4). In this study, we investigated the association between parental carbohydrate counting knowledge and glycemic control in youth with type 1 diabetes.