Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: an 18-month observational study.
OBJECTIVE
This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections.


METHODS
We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months.


RESULTS
At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14 ± 0.41% at 6 months vs. 7.35 ± 0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95 ± 0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018).


CONCLUSIONS
CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.
Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy.
Ivana
I
Rabbone
Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy. Electronic address: scaramuzza.andrea@hsacco.it.
Andrea E
AE
Scaramuzza
Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy.
Maria Giovanna
MG
Ignaccolo
Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy.
Davide
D
Tinti
Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy.
Sabrina
S
Sicignano
Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy.
Francesca
F
Redaelli
Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy.
Laura
L
De Angelis
Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy.
Alessandra
A
Bosetti
Department of Paediatrics, Azienda Ospedaliera, University of Milano, "Ospedale Luigi Sacco", via G.B. Grassi 74, 20157 Milano, Italy.
Gian Vincenzo
GV
Zuccotti
Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy.
Franco
F
Cerutti
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007003:Hypoglycemia / Q000188:drug therapy; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D011446:Prospective Studies
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
Bolus calculator; Carbohydrate counting; Childhood diabetes; Education; Insulin therapy; Type 1 diabetes