SAT131 Acceptability And Impact Of Basic Carbohydrate Counting On Glycemic Control In Children And Young People With Type 1 Diabetes

Abstract

Abstract Disclosure: A. Tandon: None. E. Bhowmik: None. Z. Ali: None. S. Tripathi: None. A. B k: None. V. Bhatia: None. P. Dabadghao: None. S. Sudhanshu: None. Background- Basic carbohydrate counting (BCC) represents a meal-planning approach for people with T1DM, emphasizing on consistency in the timing and amount of carbohydrate intake at each meal. In contrast to advanced carbohydrate counting, it is simpler to learn for people with varied levels of education or numeracy skills. The effect of BCC on glycemic control in children with T1DM using MDI is largely unknown. We aimed to determine whether BCC, compared to routine nutritional education (RNE) of our clinic, would improve glycemic control in these children with typical Indian diets. Methods- This randomized, controlled trial included children, adolescents and young adults with T1DM using MDI. In addition to RNE, the intervention group received BCC education including a personalised diet plan with suggestions for carbohydrate exchanges at each meal based on a 2-week food log prepared by them. The control group received the RNE of our clinic including instructions on healthy food choices, food groups, calorie-free foods, glycemic index, and instructions for special occasions. A retrospective CGM study and HbA1c were performed at baseline and at 12 weeks after the dietary education. The primary outcome was the difference in change in TIR (Time in range; 70-180 mg/dl) from baseline through 12 weeks between the two groups. A questionnaire on acceptability of BCC was administered. Results- Ninety two patients [age 15.7 ± 5.0 years, median (IQR) duration of diabetes 5.9 (5.9) years, baseline HbA1c 8.0 ± 1.5 %] wore the FreeStyle Libre Pro sensor for a median of 14 days. Median (IQR) TIR was 41 (18) %, TBR (Time below range; <70 mg/dl) 14 (13) % and TAR (Time above range; >180 mg/dl) 40.7 ± 20.4 %. Coefficient of variation (% CV) was 49.1±10.3% and 92% had high (>36 %) CV. Multivariate regression showed that older age at onset of diabetes was associated with a higher TIR, TBR and a lower TAR, whereas these glycemic metrics were not influenced by current age, urban vs rural residence, education of mother or socioeconomic status. The use of NPH vs glargine for basal insulin was also associated with higher TBR and %CV but lower TAR. Significant improvement was seen in HbA1c in the BCC group, when compared with their own values during the prior 24 months (baseline [8.2 ± 1.3%], 12 weeks [7.9 ± 1.2%], p = 0.042), but not so in the RNE group (baseline [8.0 ± 1.0%], 12 weeks [8.1 ± 1.0%], p = 0.881). However, no significant differences were observed in the changes in TIR, TBR, TAR, %CV and HbA1c between the two groups after 12 weeks of dietary intervention. Although, acceptability of BCC was high, only half of the participants correctly practiced it at more than 50 percent of their meals. Conclusion- Among our families with T1DM treated with MDI, although BCC had high acceptability, it was not frequently practiced and did not lead to greater improvement in glycemic control as compared to routine nutritional education. Presentation: Saturday, June 17, 2023