Does meal-time insulin dosing based on fat-protein counting give positive results in postprandial glycaemic profile after a high protein-fat meal in adolescents with type 1 diabetes: a randomised controlled trial.

Abstract

The present study investigated the effects of fat-protein (CFP) counting in addition to carbohydrate (CARB) counting for calculating prandial insulin dosage on blood glucose profile in patients with type 1 diabetes (T1D) on basal-bolus insulin therapy. In this single centre, cross-over, randomised, controlled study, control meal (SM: standard meal using a carbohydrate counting method) and three test meals (HPM: high protein meal using a carbohydrate counting method; HPFM-a: high protein-fat meal using a carbohydrate counting method; HPFM-b: high protein-fat meal using a carbohydrate and fat-protein counting method) were compared on postprandial early (0-120min), late (120-240min) and total (0-240min) glucose response in 30 patients with T1D, aged 16-18years. The glucose levels of 0-90min did not change after different meal consumptions (P>0.05), whereas 120-240min glucose levels were higher after HPFM-a consumption compared to HPFM-b consumption (P<0.05). There were no significant differences between meals with respect to the early postprandial glucose response (0-120min) (P=0.405). In late response (120-240min), HPFM-b [area under the curve (AUC)=20609 (582)mg dL-1 ×dk] was significantly lower than SM [AUC=24092 (9015)mg dL-1 ×dk], HPM [AUC=24072(5853)mg dL-1 ×dk] and HPFM-a [AUC=25986(6979)mg dL-1 ×dk] (P=0.032). Meal-related insulin dosing based on carbohydrate plus fat/protein counting has given positive results in the postprandial glycaemic profile as a result of lower postprandial glycaemic levels compared to conventional carbohydrate counting in patients with T1D after a high protein-fat meal.