Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus

Centenaro, Analaura; do Nascimento, Cigléa; Beretta, Mileni Vanti; Rodrigues, Ticiana da Costa

doi:10.20945/2359-3997000000596

Analaura Centenaro

conception and design of the research

acquisition and analysis of the data

interpretation of the data

drafted the manuscript

critically revised the manuscript

agree to be fully accountable for ensuring the integrity and accuracy of the work

read and approved the final manuscript

Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil

http://orcid.org/0000-0001-8910-2457

Cigléa do Nascimento

conception and design of the research

critically revised the manuscript

agree to be fully accountable for ensuring the integrity and accuracy of the work

read and approved the final manuscript

Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil

http://orcid.org/0000-0003-3791-1564

Mileni Vanti Beretta

conception and design of the research

critically revised the manuscript

agree to be fully accountable for ensuring the integrity and accuracy of the work

read and approved the final manuscript

Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil

http://orcid.org/0000-0002-9246-1562

Ticiana da Costa Rodrigues Correspondence to: Ticiana da Costa Rodrigues, Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos, 2.350 90035-903 – Porto Alegre, RS, Brasil. ticianacr@yahoo.com.br

conception and design of the research

interpretation of the data

critically revised the manuscript

agree to be fully accountable for ensuring the integrity and accuracy of the work

read and approved the final manuscript

Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS); Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brasil

Hospital de Clínicas de Porto Alegre, Divisão de Endocrinologia, Porto Alegre, RS, Brasil

http://orcid.org/0000-0001-9254-3712

Correspondence to: Ticiana da Costa Rodrigues, Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos, 2.350 90035-903 – Porto Alegre, RS, Brasil. ticianacr@yahoo.com.br

Disclosure: no potential conflict of interest relevant to this article was reported.

Variable		CC (n = 49)	Not CC (n = 180)	p value
Age, years^§ § Referring to baseline (first consultation included during the period 2014 and 2018).		32.91 ± 11.31	30.7 ± 16.26	0.275
Nutritional follow-up time, months^§ § Referring to baseline (first consultation included during the period 2014 and 2018).		97 (5.5-129.5)	43.5 (0-126.75)	0.045
Diabetes duration, months^§ § Referring to baseline (first consultation included during the period 2014 and 2018).		195 (112-265)	147 (33.5-266.55)	0.1
BMI (kg/m²)^§ § Referring to baseline (first consultation included during the period 2014 and 2018).		24.4 ± 4.26	23.6 ± 4.7	0.284
Age at DM diagnosis, years		16 (10.5-24.5)	14 (8.25-25)	0.588
Males (n, %)		20 (40.8)	84 (46.7)	0.570
Ethnicity (n, % white)		49 (100)	161 (89.4)	0.045
Maximum education (n, %)
	Ignored/≤ complete elementary	15 (30.7)	86 (47.8)
	High school	15 (30.6)	68 (37.7)
	≥ Incomplete higher education	19 (38.7)	26 (14.5)	0.001
Pregnant women (n, %)⁺ + Number along follow-up consultations.		5 (10.2)	1 (0.55)	0.003
Number of consultations^# # All consultations between 2014 and 2018 were considered in the CC group, including those in which patients used fixed doses of insulin.		10 (6 - 14)	5 (3 - 9)	0.000
DKD (n, %)^* * Occurring prior to or during the follow-up period.		1 (2)	14 (7.8)	0.202
GFR < 60 (mL/min/1.73 m²) (n, %)^* * Occurring prior to or during the follow-up period.		1 (2)	15 (8.3)	0.204
Positive albuminuria (n, %)^* * Occurring prior to or during the follow-up period.		38 (77.6)	127 (70.6)	0.431
Neuropathy (n, %)^* * Occurring prior to or during the follow-up period.		2 (4.1)	15 (8.3)	0.538
Retinopathy (n, %)^* * Occurring prior to or during the follow-up period.		23 (46.9)	60 (33.3)	0.112
Cardiovascular events (n, %)^* * Occurring prior to or during the follow-up period.		1 (2)	1 (0.6)	0.383
Ocular diseases (n, %)^* * Occurring prior to or during the follow-up period.		1 (2)	15 (8.3)	0.204
Autoimmune diseases (n, %)^* * Occurring prior to or during the follow-up period.		10 (20.4)	34 (18.9)	0.972
Psychiatric disorders (n, %)^* * Occurring prior to or during the follow-up period.		10 (20.4)	41 (22.8)	0.873
Thyroid diseases (n, %)^* * Occurring prior to or during the follow-up period.		13 (26.5)	38 (21.1)	0.539
Hypertension (n, %)^* * Occurring prior to or during the follow-up period.		8 (16.3)	42 (23.3)	0.391

Variable		CC (n = 49)	Not CC (n = 180)	p value^§ § p value of the effect of the variable.	p for interaction^¶ ¶ p of interaction between the effect of the variable and time.
Fasting glucose (mg/dL)^* * Continuous variables presented as mean ± SE and 95% CI.		203.42 ± 11.23 (182.53-226.7)	207.87 ± 5.93 (196.55-219.84)	0.918	0.741
Total cholesterol (mg/dL)^* * Continuous variables presented as mean ± SE and 95% CI.		178.81 ± 7.17 (165.24-193.5)	186.42 ± 3.96 (178.78-194.39)	0.522	0.761
cHDL (mg/dL)^* * Continuous variables presented as mean ± SE and 95% CI.		58.11 ± 2.87 (52.72-64.05)	58.98 ± 1.57 (55.97-62.15)	0.61	0.606
cLDL (mg/dL)^* * Continuous variables presented as mean ± SE and 95% CI.		102.72 ± 5.57 (92.31-114.31)	106.39 ± 3.11 (100.42-112.71)	0.458	0.684
Triglycerides (mg/dL)^* * Continuous variables presented as mean ± SE and 95% CI.		88.44 ± 8.9 (72.53-107.83)	97.31 ± 5.3 (87.41-108.33)	0.91	0.106
GFR (mL/min/1.73m²)^* * Continuous variables presented as mean ± SE and 95% CI.		102.4 ± 4.57 (93.79-111.81)	99.03 ± 2.25 (94.71-103.56)	0.654	0.615
SMBG^ Dichotomous variables presented as estimated proportion (%) ± SE and 95% CI.
	Yes	92.2 ± 2.4 (86-95.7)	84.4 ± 1.8 (80.6-87.6)	0.005	0.127
Insulin dose^* * Continuous variables presented as mean ± SE and 95% CI. (UI/kg)		0.66 ± 0.03 (0.6-0.73)	0.71 ± 0.02 (0.67-0.75)	0.199	0.607
Basal insulin^ Dichotomous variables presented as estimated proportion (%) ± SE and 95% CI.
	Long-acting analogs	60.7 ± 6.8 (46.9-73)	42.4 ± 3.6 (35.6-49.5)	0.055	0.129
Bolus insulin^ Dichotomous variables presented as estimated proportion (%) ± SE and 95% CI.
	Rapid-acting analogs	100 ± 0 (82.1-100)	77.9 ± 3.1 (71.3-83.4)	0.000	0.163
Nutritional status^ Dichotomous variables presented as estimated proportion (%) ± SE and 95% CI.
	Excess body weight	40 ± 6.5 (28.4-53.5)	43 ± 3.5 (36.4-50)	0.813	0.653

HbA1c (%)^* * HbA1c measured at each nutritional consultation during follow-up (2014 and 2018); presented as mean ± SE and 95% CI.	CC (n = 49)	Not CC (n = 180)	p value^§ § p value of the effect of the variable.	p for interaction^¶ ¶ p of interaction between the effect of the variable and time.
Model 0	8.2 ± 0.21 (7.8 to 8.63)	9.13 ± 0.12 (8.89 to 9.38)	0.000	0.735
Model 1	8.66 ± 0.4 (7.9 to 9.5)	9.36 ± 0.39 (8.62 to 10.16)	0.016	0.841
Model 2	8.26 ± 0.58 (7.19 to 9.49)	8.82 ± 0.55 (7.8 to 9.98)	0.107	0.999

Weight variation (kg)^* * Variable measured at each nutritional consultation between 2014 and 2018 and presented as mean ± SE and 95% CI.	CC (n = 49)	Not CC (n = 180)	p value^§ § p value of the effect of the variable.	p for interaction^¶ ¶ p of interaction between the effect of the variable and time.
Model 0	0.23 ± 0.13 (-0.033 to 0.492)	0.43 ± 0.07 (0.28 to 0.58)	0.045	0.14
Model 1	0.27 ± 0.29 (-0.3 to 0.85)	0.52 ± 0.25 (0.02 to 1.02)	0.027	0.082
Model 2	0.2 ± 0.29 (-0.378 to 0.79)	0.516 ± 0.25 (0.004 to 1.02)	0.023	0.11
Model 3	0.13 ± 0.28 (-0.42 to 0.69)	0.53 ± 0.24 (0.04 to 1.02)	0.024	0.226

[1] Correspondence to: Ticiana da Costa Rodrigues, Divisão de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA) Rua Ramiro Barcelos, 2.350 90035-903 – Porto Alegre, RS, Brasil. ticianacr@yahoo.com.br

Brasil

Brasil

Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus

ABSTRACT

Objective:

Materials and methods:

Results:

Conclusion: