Knowledge of carbohydrate counting and insulin dose calculations in paediatric patients with type 1 diabetes mellitus

Abstract

BackgroundPatients with type 1 diabetes mellitus (T1DM) who are able to adjust their insulin doses according to the carbohydrate content of a meal, as well as their blood glucose, are likely to have improved glycaemic control (Silverstein et al., 2005). With improved glycaemic control, patients have a lower risk of developing long-term microvascular complications associated with T1DM (Diabetes Control and Complications Trial Research Group, 1993).To assess the carbohydrate and insulin knowledge of patients attending our paediatric diabetes clinic at the University Hospital Limerick (UHL), the validated PedCarbQuiz (PCQ) was applied to our clinic population.MethodsThis study was completed by applying a questionnaire called the PedCarbQuiz (PCQ) to children exclusively attending our paediatric diabetes clinic at UHL. Of the clinic's 220 patients, 81 participated in the study.ResultsThe average total PCQ score (%) was higher in the continuous subcutaneous insulin infusion (CSII) group compared with the multiple daily insulin (MDI) injection user group (79.1 ± 12.1 versus 65.9 ± 6.6 p = 0.005). The CSII group also had a higher average carbohydrate score (%) compared with the MDI group (79.4 ± 12.4 versus 66.3 ± 16.2, p = 0.004).ConclusionsThis study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is better among patients treated with CSII compared with MDI. However, knowledge in both groups is poorer than in the original US sample.General significanceThis study demonstrates that in a representative Irish regional paediatric T1DM clinic, knowledge of carbohydrates and insulin is poorer than in a US based sample, although this knowledge is better among patients treated with CSII compared with MDI. This highlights the need for improved resources for diabetes and carbohydrate counting education for patients with T1DM.

One potato, two potato,… assessing carbohydrate counting accuracy in adolescents with type 1 diabetes

“…To our knowledge, there have been only three previous studies examining CHO counting accuracy in the adolescent age range using commonly eaten food items, [13][14][15] and one recent study investigating CHO counting knowledge through PCQ scores in a clinic population. 24 Two American studies, using similar methodology to our study, found that 23% and 55% of adolescents tested were accurate within 10 g. 13,15 The study demonstrating the highest rate of inaccuracy had a small sample (n = 49) and may not, therefore, have been representative of the broader clinic population. A study from Australia, using varying methods of CHO estimation (1 g increments, 10 g portion sizes, 15 g exchanges) found that 43% were accurate within 5 to 7 g and 73% within 10 to 15 g. 14 A notable difference in this study is that the participants included parents.…”

“…The mean score for CHO estimation was lower than ours at 68%. Differences in this study included primarily parental participation (82.7%) and a smaller sample size ( n = 81) . A further issue is that the PCQ has only been validated in a North American population, and differences in common foods eaten may lead to falsely low scores due to unfamiliarity with the food item.…”

“…To our knowledge, there have been only three previous studies examining CHO counting accuracy in the adolescent age range using commonly eaten food items, and one recent study investigating CHO counting knowledge through PCQ scores in a clinic population …”

The Association between the Parents’ Knowledge of Carbohydrate Counting and the Glycaemic Control of the Children with Type 1 Diabetes

“…In the present study population less than 1/3 rd had good knowledge about carbohydrate counting, with nearly 69.5% either over/underestimating the carbohydrate values in the meal. Previous studies from western developed countries such as USA and Ireland have demonstrated better carbohydrate counting knowledge among parents [ 11 , 18 ]. The observed difference could be due to the better socioeconomic status and health literacy in these countries, in comparison to Sri Lanka.…”

Variation of carbohydrate intake in diabetic children on carbohydrate counting

“…Pump bolus wizards are easier to use. In addition, it appears that children on IP have a better knowledge of CC than patients on SII (21).…”