title: Carbohydrate-to-Insulin Ratio in a Mediterranean Population of Type 1 Diabetic Patients on Continuous Subcutaneous Insulin Infusion Therapy.
abstract: BACKGROUND
  The carbohydrate-to-insulin ratio (CIR) is initially calculated from the total daily insulin dose (TDID). However, CIR likely presents variations owing to different population characteristics and intraday variations not being taken into account by most formulas. No information is available concerning the Mediterranean population. We investigated the CIR used by patients with type 1 diabetes (T1DM) using continuous subcutaneous insulin infusion (CSII) therapy in a Mediterranean area, to identify possible intraday variations and establish an adequate formula to calculate CIR.
  
  
  METHODS
  Data from 170 T1DM patients from Barcelona were obtained retrospectively from the Spanish National Registry of CSII Therapy (SNR-CSII). Theoretical CIR was calculated using the formula: 500 divided by TDID. This theoretical CIR was compared to the real CIR.
  
  
  RESULTS
  The real CIR was also compared between main meals. Patients with HbA1c < 7% (n = 44) were considered a reference group for accurate bolus calculation and were analyzed as a subgroup. The real CIR used was 11.5 g/UI for breakfast, 12 g/UI for lunch, and 13.3 g/UI for dinner. CIR obtained by the 500/TDID formula for all meals was 15.5 g/UI. We obtained similar results for the group with HbA1c < 7%. The real CIR differed significantly from the theoretical CIR values and between breakfast and the other main meals (P < .005).
  
  
  CONCLUSIONS
  CIR in our population was significantly lower for breakfast than for other meals. CIR using the 500/TDID formula underestimated prandial insulin requirements. A calculation of 350/TDID for breakfast and 400/TDID for lunch and dinner would be more appropriate for this population.
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain Valcantara@santpau.cat.
authors.forename: Valeria
authors.initials: V
authors.lastname: Alcántara-Aragón
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain EDUAB-HSP Group, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain CIBER BBN, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Cintia
authors.initials: C
authors.lastname: Gonzalez
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain EDUAB-HSP Group, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain CIBER BBN, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Corcoy
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
authors.forename: Justa
authors.initials: J
authors.lastname: Ubeda
authors.affiliation: Endocrinology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain EDUAB-HSP Group, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain CIBER BBN, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Chico
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D004040:Dietary Carbohydrates / Q000032:analysis*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood* / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D008297:Male; D019083:Mediterranean Region; D008875:Middle Aged; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013030:Spain
chemical_list: D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: bolus calculator; carbohydrate counting; continuous subcutaneous insulin infusion therapy; insulin-to-carbohydrate ratio; type 1 diabetes