Carbohydrate counting (CHC) is a method to estimate the insulin bolus which aims is to reduce post-prandial glycemic excursion. CHC must be integrated into the nutritional education of type 1 diabetes and managed by multidisciplinary team.
In view of the growing importance of CHC in Hybrid Cloosed Loop Insulin Delivery Systems, we tried to understand if the educational effort of the caring team to train the patient to the use of CHC reaches the goal: long term use of this method.
Fifty-six children and adolescents with type 1 diabetes treated with insulin pump, and their parents, were enrolled for the study and answered the survey. They and their parents had been trained for CHC almost one year before the survey and, in post-training visits, learning was reinforced.
One year after the CHC training, 6 patients (10,7%) dropped out insulin pump therapy. Twenty-three patients (41%) didn’t use CHC and 5 patients (9.5%) used it rarely. Between the “non users” 51% was not able in the counting, 14% didn’t trust of the bolus calculator, 20% thought they didn't need it, 15% considered it too complex.
This survey shows that CHC is not suitable for all patients. This could be a problem for Hybrid Cloosed Loop Systems that need the correct use of the bolus calculator. Such systems should minimize the patient's engagement in bolus management and so they could be used by a wider population of patients.