Does Carbohydrate Counting from Diabetes Onset Make a Difference to Glycemic Outcomes? A Swedish Registry Study

Carbohydrate counting (CC) for calculating insulin for meals is recommended in type 1 diabetes to optimize the postprandial glycemic response. Few studies have studied the effect of CC on glycemic outcomes when introduced from diabetes diagnosis. Our aim was to investigate if CC effects metabolic outcomes over time between individuals taught CC from diabetes onset and those who were not. A secondary aim was to examine if use of CC was associated with glycemic outcomes at 8 years diabetes duration.

This was a cohort study analyzing pediatric data from the Swedish Diabetes Registry (NDR), comparing two groups with diabetes onset 2011-2013, where one was taught CC from diagnosis and the other group used fixed doses. HbA1c data were analyzed from first year of diabetes up to 8 years. A cross-sectional analysis at 8 years diabetes duration, compared groups with reported use of CC to the NDR to examine the association with glycemic outcomes.

There was no difference in HbA1c over time between the group taught CC from diagnosis (n = 253) and those that were not (n = 221) after adjusting for gender, age, and insulin regimen (difference fixed CC: 1.0; 95% confidence interval: -0.8 to 2.9; p = 0.27). The group using CC after 8 years duration had significantly lower HbA1c than those not using CC (56.2 mmol/L vs. 64.8 mmol/L, p = <0.001).

The results suggest that CC can be effective in achieving target glycemic outcomes over time and support its introduction at any time in the life course to improve metabolic outcomes.