Optimizing insulin delivery: assessment of three strategies in intensive diabetes management

“…It helps to avoid both hyper and hypoglycemia [1,2,3,4,5,6,7] once it tries to match the amount of carbohydrates (CH) consumed on the meal with prandial insulin dose. The 2 main parameters that are used in the CC method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF).…”

Section: Introductionmentioning

confidence: 99%

“…Based on data obtained in non-pregnant individuals with T1DM, CC seems attractive also for pregnant populations because during pregnancy, the rise in counter-regulatory hormones favors postprandial hyperglycemia, which can be addressed using the CC strategy [3,5,14]; the flexibility that CC confers is interesting for the mother who has unpredictable food ingestion as a consequence of the periods of nausea [15]; the costs of its implementation are low and thus feasible in almost all social groups and clinical environments [7]; CC can help to minimize both hyper and hypoglycemia [1,2,3,4,5,6], situations that are especially detrimental during gestation and CC is associated with a better quality of life [6]. …”

Section: Introductionmentioning

confidence: 99%

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

et al. 2017

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Background/Aims: Carbohydrate counting (CC) is a helpful strategy for the treatment of type 1 diabetes mellitus (T1DM) and the main parameters used in this method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF). Throughout pregnancy, a state of insulin resistance develops. Therefore, we hypothesized that ICR and SF change and our aim was to describe the pattern of modification of these parameters in pregnant women with T1DM on CC. Methods: This study followed 21 women with T1DM throughout pregnancy. Starting ICR was 1:15 and SF was calculated using the formula: 1,500/total daily insulin dose (TDID; for regular insulin) or 1,800/TDID (for ultra-rapid analogs). ICR was adjusted every 1-2 weeks according to self-monitoring of blood glucose. SF was recalculated every 1-2 weeks. Results: Throughout gestation there was a mean decrease in the ICR in breakfast, lunch and dinner of 8.2 (p < 0.0001), 7.7 (p = 0.003) and 7 (p = 0.005) grams per international units (g/IU), respectively. Mean SF reduction from first to third trimester was 10 mg/dL per IU (mg/dL/IU; p < 0.0001). Conclusions: Women with T1DM in CC during pregnancy evolve with a progressive reduction in the ICR at every meal (mean of 8.2 g/IU for breakfast, 7.7 g/IU for lunch and 7 g/IU for dinner) and also in the SF (10 mg/dL/IU).

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“…At present, study to inquiry the effect of carbohydrate counting on T1DM patients is relatively little. Evidence from randomized controlled trials (RCTs) reported inconsistent results567. Previous systematic review8 or meta-analysis9 did not cite a clear conclusion.…”

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confidence: 99%

Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis

Deng

et al. 2016

Sci Rep

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Potential benefits of carbohydrate counting for glycemic control in patients with type 1 diabetes mellitus (T1DM) remain inconclusive. Our aim is to systematically assess the efficacy of carbohydrate counting in patients with T1DM. We searched PubMed, Embase, Web of Science, Cochrane Library and the Chinese Biology Medicine (CBM) up to December 2015. Randomized controlled trials (RCTs) with at least 3 months follow-up that evaluated carbohydrate counting compared with usual or other diabetes dietary education in patients with T1DM were included. Overall meta-analysis identified a significant decrease in HbA1c concentration with carbohydrate counting versus other diabetes diet method or usual diabetes dietary education (SMD: −0.35, 95%CI: −0.65 to −0.05, P = 0.023). Subgroup analysis restricted to trials which compared carbohydrate counting with usual diabetes dietary found a significant decrease in HbA1c in carbohydrate counting group (SMD: −0.68, 95%CI: −0.98 to −0.38, P = 0.000), and a similar result has emerged from six studies in adults (SMD: −0.40, 95%CI: −0.78 to −0.02, P = 0.037). Carbohydrate counting may confer positive impact on glucose control. Larger clinical trials are warranted to validate this positive impact.

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Optimizing insulin delivery: assessment of three strategies in intensive diabetes management

Abstract: These results indicate that a strategy that allows for flexibility of self-adjustments of insulin and is not very complex (such as QUAL) may be the strategy of choice for intensive management programmes.

Cited by 32 publications

References 15 publications

Targeting postprandial hyperglycemia

Targeting postprandial hyperglycemia

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis

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