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Efficacy of Bolus Calculation and Advanced Carbohydrate Counting in Type 2 Diabetes: A Randomized Clinical Trial

Merete B Christensen1,2, Nermin Serifovski1,2, Anne M H Herz1

  • 1Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark.

Diabetes Technology & Therapeutics
|August 27, 2020
PubMed

Insights

Advanced carbohydrate counting (ACC) and automated bolus calculators (ABCs) effectively reduced HbA1c in type 2 diabetes. Both methods, including manual calculation, improved glycemic control without increasing hypoglycemia.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Limited evidence exists on the efficacy of carbohydrate counting and automated bolus calculators (ABCs) for glycemic control in type 2 diabetes.
  • Type 2 diabetes management often involves basal-bolus insulin therapy, requiring precise insulin dosing.

Purpose of the Study:

  • To evaluate the efficacy of advanced carbohydrate counting (ACC) and automated bolus calculators (ABCs) compared to manual insulin bolus calculation (MC) in type 2 diabetes patients on basal-bolus insulin.
  • To assess changes in HbA1c, glycemic variability, hypoglycemia, and body mass index (BMI).

Main Methods:

  • A 24-week, open-label, randomized clinical study involving 79 individuals with type 2 diabetes on basal-bolus insulin.
  • Participants were randomized to either an ABC group (trained in ACC and ABC use) or an MC group (trained in ACC and manual calculation).
  • Continuous glucose monitoring (CGM) was used at baseline and study end to assess glycemic parameters.

Main Results:

  • Both the ABC and MC groups achieved a significant reduction in HbA1c (0.8%) with no significant difference between the groups.
  • Glycemic variability decreased significantly in both groups.
  • No increase in hypoglycemia or BMI was observed, and treatment satisfaction improved in both groups.

Conclusions:

  • Advanced carbohydrate counting (ACC) is an effective, low-cost strategy for reducing HbA1c and glycemic variability in type 2 diabetes patients on basal-bolus insulin.
  • The use of automated bolus calculators (ABCs) offers similar benefits to manual calculation in this population, without increasing hypoglycemia or BMI.
  • Both ACC and insulin bolus calculation methods enhance treatment satisfaction in type 2 diabetes management.

Keywords:
Automated bolus calculatorsCarbohydrate countingGlycemic variabilityInsulin therapyType 2 diabetes

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