Carbohydrate counting improves coping ability and metabolic control in patients with Type 1 diabetes managed by Group Care.
OBJECTIVE
To assess, in patients with Type 1 diabetes (T1DM), the effects of adding a carbohydrate counting programme (CCP) to continuing education by Group Care on coping ability, quality of life (QoL), knowledge of diabetes, and metabolic control.


METHODS
Out of 56 patients with T1DM followed by Group Care, 27 were randomized to receive an 8-session CCP and 29 controls continued Group Care without a CCP. QoL, knowledge, and coping ability were assessed at baseline and after 30 months. Glycated hemoglobin (HbA1c), body weight, blood glucose, hypoglycemic episodes, and insulin dosages were checked every 3 months.


RESULTS
QoL improved (p<0.0001) in both CCP (88.7 ± 9.2 vs 78.0 ± 9.9) and control patients (88.7 ± 12.5 vs 80.4 ± 11.7). At the end of study, patients on CCP had better scores in knowledge [difference 0.72 (95% CI 0.44; 0.99), p<0.0001] and the 3 coping areas [problem solving: 1.75 (1.2; 2.3), p<0.0001; social support seeking: -1.4 (-2.3; -0.48) p<0.005; avoidance: -1.59 (-2.6; -0.56), p<0.005] than controls. All variables showed a greater, although not statistically significant, improvement in patients with poor schooling. At 30 months, HbA1c was lower in the CCP patients than controls (7.2 ± 0.9 vs 7.9 ± 1.4), p<0.05. There were no changes in insulin dosage, hypoglycemic episodes or blood lipids.


CONCLUSIONS
This study confirms that Group Care improves QoL in people with T1DM, but suggests that specific educational and psychological supports are needed to modify adaptation to the disease. The CCP we developed appears effective in promoting change, also in patients with poor schooling.
Trento
M
M
Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Corso AM Dogliotti 14, I-10126 Turin, Italy. marina.trento@unito.it
Trinetta
A
A
Kucich
C
C
Grassi
G
G
Passera
P
P
Gennari
S
S
Paganin
V
V
Tedesco
S
S
Charrier
L
L
Cavallo
F
F
Porta
M
M
D000223:Adaptation, Psychological; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000503:physiopathology / Q000523:psychology*; D004040:Dietary Carbohydrates / Q000032:analysis*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D012944:Social Support
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin