Abstract
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.
Highlights
A (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement) statement[13,14]
The search strategy included following terms: “carbohydrate counting”, “Type 1 diabetes mellitus”, “Glycated hemoglobin” and “HbAlc”
Compared with other diabetes diet method or usual diabetes dietary education, carbohydrate counting significantly reduced HbA1c concentration (SMD: −0.35, 95%confidence interval (CI): −0.65 to −0.05, P = 0.023), with significant heterogeneity (I2 = 71.2%, P < 0.001)
Summary
HbAlc (follow-up 3 to 30 months; measured with: Blood test; range of scores: 7–9; Better indicated by lower values) randomised trials serious serious no serious no serious strong indirectness imprecision association. 0.05 lower) hypoglycaemic (follow-up 4 to 12 months; measured with: recall; range of scores: 4–6; Better indicated by lower values) randomised trials no serious risk of bias no serious inconsistency no serious indirectness serious reporting bias strong association lower 0.1 higher) insulin dose (follow-up 12 to 24 months; measured with: record and calculation; range of scores: 4–6; Better indicated by lower values) no serious inconsistency no serious indirectness serious higher BMI (follow-up mean 24 to 30 months; measured with: calculation; range of scores: 4–6; Better indicated by lower values) no serious inconsistency no serious indirectness no serious imprecision reporting bias strong association lower
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