Does Carbohydrate Counting from Diabetes Onset make a Difference to Glycemic Outcomes? A Swedish Registry Study.

Background Carbohydrate counting (CC) for calculating insulin for meals is recommended in type 1 diabetes to optimize the postprandial glycemic response. Few studies have studied the effect of CC on glycemic outcomes when introduced from diabetes diagnosis. Research aims To investigate if CC effects metabolic outcomes over time between individuals taught CC from diabetes onset and those who were not. A secondary aim was to examine if use of CC was associated with glycemic outcomes at eight years diabetes duration. Method This was a cohort study analysing pediatric data from the Swedish Diabetes Registry (NDR), comparing two groups with diabetes onset 2011-2013, where one was taught CC from diagnosis and the other group used fixed doses. HbA1c data was analysed from first year of diabetes up to eight years. A cross-sectional analysis at eight years diabetes duration, compared groups with reported use of CC to the NDR to examine the association with glycemic outcomes. Results There was no difference in HbA1c over time between the group taught CC from diagnosis (n=253) and those that were not (n=221) after adjusting for gender, age and insulin regimen (difference fixed-CC:1.0; 95% CI -0.8 to 2.9; p=0.27). The group using CC after eight years duration had significantly lower HbA1c than those not using CC (56.2 mmol/L vs 64.8 mmol/L p=<.001). Conclusions The results suggest that CC can be an effective in achieving target glycemic outcomes over time and support its introduction at any time in the life course to improve metabolic outcomes.