Practices, perceptions and expectations for carbohydrate counting in patients with type 1 diabetes – Results from an online survey

Fortin, Andrée; Rabasa‐Lhoret, Rémi; Roy‐Fleming, Amélie; Desjardins, Katherine; Brazeau, Anne‐Sophie; Ladouceur, Martin; Gingras, Véronique

doi:10.1016/j.diabres.2017.02.022

Cited by 30 publications

(31 citation statements)

References 38 publications

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“…Any technology or strategy that would alleviate the burden of CHO counting could not only improve overall glycaemic control but patients' life quality as well. Patients with T1D have expressed their interest in a device that would help minimize their disease burden and simplify their day‐to‐day management . CLS offers the perspective of CHO counting alleviation or simplification; yet, it should not be achieved at the expense of effective postprandial glucose control.…”

Section: Postprandial Glucose Controlmentioning

confidence: 99%

“…Using a CLS, Wolpert et al showed that a high‐fat meal compared with a low‐fat meal with similar protein and CHO content resulted in more insulin requirements and increased BG . Accurate CHO counting is an essential aspect to manage postprandial BG levels in T1D and already constitutes a challenging task for most patients with T1D; thus, adding protein and lipid aspects to prandial insulin bolus calculations would considerably increase the complexity of post‐meal glucose control for patients. In CLS, a meal bolus strategy that does not require proteins and lipids counting without compromising post‐meal glucose control would greatly simplify patients' treatment.…”

Section: Challenges and Technical Issuesmentioning

confidence: 99%

“…Self‐management in T1D involves multiple day‐to‐day tasks including, but not limited to, insulin dose adjustments, self‐monitoring of BG, hypoglycaemia management and carbohydrate (CHO) counting. These tasks can be challenging and compliance is often limited …”

Section: Introductionmentioning

confidence: 99%

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The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Gingras

Taleb

Roy‐Fleming

et al. 2017

Diabetes Obesity Metabolism

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For patients with type 1 diabetes, closed-loop delivery systems (CLS) combining an insulin pump, a glucose sensor and a dosing algorithm allowing a dynamic hormonal infusion have been shown to improve glucose control when compared with conventional therapy. Yet, reducing glucose excursion and simplification of prandial insulin doses remain a challenge. The objective of this literature review is to examine current meal-time strategies in the context of automated delivery systems in adults and children with type 1 diabetes. Current challenges and considerations for post-meal glucose control will also be discussed. Despite promising results with meal detection, the fully automated CLS has yet failed to provide comparable glucose control to CLS with carbohydrate-matched bolus in the post-meal period. The latter strategy has been efficient in controlling post-meal glucose using different algorithms and in various settings, but at the cost of a meal carbohydrate counting burden for patients. Further improvements in meal detection algorithms or simplified meal-priming boluses may represent interesting avenues. The greatest challenges remain in regards to the pharmacokinetic and dynamic profiles of available rapid insulins as well as sensor accuracy and lag-time. New and upcoming faster acting insulins could provide important benefits. Multi-hormone CLS (eg, dual-hormone combining insulin with glucagon or pramlintide) and adjunctive therapy (eg, GLP-1 and SGLT2 inhibitors) also represent promising options. Meal glucose control with the artificial pancreas remains an important challenge for which the optimal strategy is still to be determined.

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Section: Postprandial Glucose Controlmentioning

confidence: 99%

Section: Challenges and Technical Issuesmentioning

confidence: 99%

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The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Gingras

Taleb

Roy‐Fleming

et al. 2017

Diabetes Obesity Metabolism

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“…Actualmente, el objetivo principal es mantener un buen control glicémico y nivel de calidad de vida 7 . Para esto, los pacientes deben inyectarse varias veces en el día y recibir insulina basal o administrar insulina subcutánea continua durante el día, mediante bomba infusora 3 . Cuando los niños comienzan con esta enfermedad, la mayoría requiere hospitalización con terapia intravenosa para tratar la cetoacidosis diabética y los problemas de deshidratación.…”

Section: Aspectos Clínicos Y Epidemiológicosunclassified

“…Su tratamiento debe contemplar una dieta alimenticia, regulación diaria de la actividad física, el uso adecuado de insulinoterapia y el control glicémico 3 . Un control inadecuado puede afectar el desarrollo, aumentar las comorbilidades, disminuir la esperanza de vida y aumentar el riesgo de complicaciones agudas y crónicas relacionadas con la diabetes 4 .…”

Section: Introductionunclassified

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias. Revisión de la literatura

Henríquez-Tejo¹,

Cartes‐Velásquez

2018

Rev. chil. pediatr.

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ResumenLa diabetes mellitus tipo 1 es la patología endocrina crónica más común en niños. El tratamiento incluye dieta, actividad física, medicación con insulina y un autocontrol adecuado. Este autocontrol puede ser dificultoso, provocando que niños, adolescentes y sus familias sufran diversas complicaciones psicosociales. Existe una relación inversa entre autocontrol y presencia de complicaciones psicosociales, siendo los principales problemas ansiedad y depresión, donde los adolescentes llegan a ser 2,3 veces más propensos a presentar problemas de salud mental. Las familias se ven afectadas inicialmente en el período de debut por un estado de shock, con sentimientos de angustia e ira. Los necesarios cambios de hábitos y estilos de vida pueden generar problemas psicosociales entre los que destacan trastornos ansiosos, depresivos y alimenticios. Posteriormente, el niño o adolescente y su grupo familiar pueden transitar a un nuevo equilibrio caracterizado por un buen autocontrol y adherencia al tratamiento o profundizar los trastornos individuales y grupales, trastornos que pueden reaparecer, especialmente en la adolescencia. El tratamiento integral de la diabetes mellitus tipo 1 requiere atender estos aspectos mediante equipos multidisciplinarios que incluyen profesionales médicos y del ámbito psicosocial. En esta revisión se analizan los principales aspectos relacionados al impacto psicosocial en niños y adolescentes con diabetes mellitus tipo 1 y sus familias. Keywords:Diabetes mellitus type 1; psychosocial impact; family AbstractType 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental

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Simplified meal announcement study (SMASH) using hybrid closed-loop insulin delivery in youth and young adults with type 1 diabetes: a randomised controlled two-centre crossover trial

Laesser,

Piazza,

Schorno

et al. 2024

Diabetologia

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Aims/hypothesis The majority of hybrid closed-loop systems still require carbohydrate counting (CC) but the evidence for its justification remains limited. Here, we evaluated glucose control with simplified meal announcement (SMA) vs CC in youth and young adults with type 1 diabetes using the mylife CamAPS FX system. Methods We conducted a two-centre, randomised crossover, non-inferiority trial in two University Hospitals in Switzerland in 46 participants (aged 12–20 years) with type 1 diabetes using multiple daily injections (n=35), sensor-augmented pump (n=4) or hybrid closed-loop (n=7) therapy before enrolment. Participants underwent two 3 month periods with the mylife CamAPS FX system (YpsoPump, Dexcom G6) to compare SMA (individualised carbohydrate meal sizes) with CC, in a randomly assigned order using computer-generated sequences. The primary endpoint was the proportion of time glucose was in target range (3.9–10.0 mmol/l) with a non-inferiority margin of 5 percentage points. Secondary endpoints were other sensor glucose and insulin metrics, usability and safety endpoints. Results Forty-three participants (18 women and girls) completed the trial. In the intention-to-treat analysis, time in range (mean±SD) was 69.9±12.4% with SMA and 70.7±13.0% with CC (estimated mean difference −0.6 percentage points [95% CI −2.4, 1.1], demonstrating non-inferiority). Time <3.9 mmol/l (median [IQR] 1.8 [1.2–2.2]% vs 1.9 [1.6–2.5]%) and >10.0 mmol/l (28.2±12.6% vs 27.2±13.4%) was similar between periods. Total daily insulin dose was higher with SMA (54.0±14.7 U vs 51.7±12.1 U, p=0.037). Three participants experienced serious adverse events, none of which were intervention-related. Conclusions/interpretation Glucose control using the CamAPS FX algorithm with SMA was non-inferior to its use with CC in youth and young adults with type 1 diabetes. Trial registration ClinicalTrials.gov NCT05481034. Funding The study was supported by the Swiss Diabetes Foundation and by a YTCR grant from the Bangerter-Rhyner Foundation and the Swiss Academy of Medical Sciences. Dexcom and Ypsomed provided product support. Graphical Abstract

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Practices, perceptions and expectations for carbohydrate counting in patients with type 1 diabetes – Results from an online survey

Cited by 30 publications

References 38 publications

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

The challenges of achieving postprandial glucose control using closed‐loop systems in patients with type 1 diabetes

Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias. Revisión de la literatura

Simplified meal announcement study (SMASH) using hybrid closed-loop insulin delivery in youth and young adults with type 1 diabetes: a randomised controlled two-centre crossover trial

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