Basic carbohydrate counting and glycemia in young people with type 1 diabetes in India: A randomized controlled trial.

OBJECTIVES: The aim of this study was to evaluate the effect on glycemic control and acceptability of basic carbohydrate counting (BCC) in children and young adults with type 1 diabetes (T1DM). METHODS: Ninety-two children and young adults (6-25 y of age) with T1DM were randomized to receive either routine nutrition education (RNE), which addressed food groups, glycemic index, and effects of food and exercise on glycemia, or learn BCC with personalized portion size education. A continuous glucose monitoring study and glycosylated hemoglobin (HbA1c) were performed at baseline and after 12 wk. The primary outcome was a change in time-in-range from baseline through 12 wk. A questionnaire on the acceptability of BCC was administered. RESULTS: At 12 wk, there was no significant difference in change in time-in-range between the two groups (BCC group: 1.2 ± 12.2; RNE group: 1.9 ± 12.3; P = 0.786). No significant changes were observed in the percentage of time that blood glucose was >180 or >250 mg/dL; <70 or <54 mg/dL; glycemic variability, percentage of nights with hypoglycemia and HbA1c. In subgroup analysis, there was a significant decrease in HbA1c in the BCC group among participants with higher maternal education (-0.5 versus 0.2, P = 0.042). The total score on the acceptability questionnaire was higher in the BCC group (P = 0.022). CONCLUSION: Among children and young adults in our region with T1DM, BCC provided flexibility in food choices and perception of greater ease of insulin adjustment. Although BCC was equivalent to RNE in terms of glycemic control, larger studies may reveal benefit in outcomes in certain subgroups.

Food Order and Timing Effects on Glycaemic and Satiety Responses to Partial Fruit-for-Cereal Carbohydrate Exchange: A Randomized Cross-Over Human Intervention Study.

Postprandial glycaemic response amplitude plays a critical role in diabetic complications, but is subject to food order and temporal separation within a meal. Effects of partial fruit-for-cereal carbohydrate exchange on glycaemic and appetite responses, as affected by food order and separation, were examined using kiwifruit (KF) and wheaten breakfast cereal biscuit (WB). In a randomized cross-over intervention study, 20 subjects ingested 51.7 g of available carbohydrate as 74 g WB alone, or as 200 g KF and 37 g WB, each delivering 25.85 g of available carbohydrate. The 200 g KF was partially exchanged for 37 g of WB, at 90 min and 30 min before, at the same time as, or 30 min after, ingesting WB. Incremental satiety responses were derived from appetite scores measured using a visual analogue scale, and capillary blood glucose responses were monitored. In all exchanges, KF reduced the glycaemic response (iAUC) by 20-30% with no loss of total satiation. The incremental glycaemic and satiety responses to food ingestion followed each other closely. Glycaemic response amplitudes were reduced almost 50% compared with 74 g WB when KF ingestion preceded WB ingestion by 30 min, and less when the KF was ingested with or 30 min after the cereal. The results suggest that fruit most effectively suppresses the digestion of cereal carbohydrates if ingested long enough before the cereal to prevent overlap of the glycaemic responses, but close enough for fruit components that impede carbohydrate digestion or uptake to interact with the ingested cereal in the gut. Ethics approval was obtained from the Human and Disabilities Ethics Committee (HDEC) of the New Zealand Ministry of Health. The trial was registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12615000744550).