title: Evaluation of the Effect of Carbohydrate Intake on Postprandial Glucose in Patients With Type 1 Diabetes Treated With Insulin Pumps.
abstract: It has been suggested that dietary freedom in functional insulin therapy may be detrimental to glycemic control in type 1 diabetes. This study evaluates the effect of carbohydrate intake on glycemic control and postprandial blood glucose concentrations.
  
  
  
  Insulin pump data from 148 adults with type 1 diabetes, trained in functional insulin therapy, using pumps for ≥6 months, with ≥2 weeks of consecutive downloaded data, ≥80% use of a bolus calculator, ≥3 capillary blood glucose tests/day, and a concurrent HbA1C, were analyzed. More detailed periprandial data (pre- and postmeal glucose, carbohydrate intake, insulin bolus) were collected from a subset of 105 downloads (3495 meals).
  
  
  
  Mean (± SD) age of contributors was 43 ± 13 years, HbA1C 7.84% ± 0.93 (62.19 mmol/mol); daily carbohydrate intake 166 ± 71 g. HbA1C reduced with increased meals/day (r = -.370, P < .0005) and increased with mean carbohydrate content/meal (r = .198, P = .043). However, total daily carbohydrate intake had a weak but significant negative association with HbA1C (r = -.181, P = .027). There was no association between standard deviation of carbohydrate intake and HbA1C (r = .021, P = .802) or between meal carbohydrate content and postprandial change in blood glucose (r = -.004, P = .939) for meals with early postprandial (1-3 hours; n = 390) readings. There was a weak positive correlation (r = .184, P = .008) between meal carbohydrate content and late (4-7 hours; n = 390) postprandial readings.
  
  
  
  With appropriate training, patients using insulin pumps can accommodate a flexible diet with variable carbohydrate intake, without detriment to glycemic control. However, large carbohydrate meals may contribute to poorer outcomes, through impact on late postprandial glycemia.
authors.affiliation: King's College London, Weston Education Centre, London, UK.
authors.forename: Mariel L
authors.initials: ML
authors.lastname: James
authors.affiliation: King's College Hospital, Denmark Hill, London, UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Green
authors.affiliation: King's College London, Weston Education Centre, London, UK.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Amiel
authors.affiliation: King's College London, Weston Education Centre, London, UK pratik.choudhary@kcl.ac.uk.
authors.forename: Pratik
authors.initials: P
authors.lastname: Choudhary
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: carbohydrate counting; functional insulin therapy; insulin pump therapy; type 1 diabetes