Counting
Carbs Improves Glycemic Control
Fitting
diabetes into their lives, rather than their lives into diabetes"
could allow more people with diabetes
to adopt intensive insulin treatment
A
week-long course (DAFNE) that teaches diabetics to adjust their
insulin intake to match their normal food consumption improves
glycemic control and reduces the impact of the disease on their lives,
British researchers said on Friday.
The technique
"provides patients with the ability to fit diabetes into their
lives, rather than their lives into diabetes" and could allow
more people with type I diabetes to adopt intensive insulin treatment,
according to Dr. Simon Heller, from Northern General Hospital in
Sheffield, and colleagues.
The researchers studied
140 type I diabetics who had moderate or poor glycemic control. Half
were immediately assigned to a 5-day "dose adjustment for normal
eating" (DAFNE) course that taught the skills to replace insulin
by matching it to desired carbohydrate intake on a meal-by-meal basis.
The other half of the
group continued as usual for 6 months before taking the training
course.
After 6 months, glycated
hemoglobin levels were significantly better in the immediate DAFNE
group (mean 8.4%) than in the delayed group (9.4%, p < 0.0001), the
researchers report in the British Medical Journal for October 5.
Questionnaires revealed
that people who took the course reported feeling a significant
improvement in the impact of diabetes on their dietary freedom and
quality of life. They also told researchers their overall well-being
was higher than did those who had not yet taken the course.
Not everyone with type I
diabetes will want to undertake intensive insulin treatment, and some
will prefer a simpler routine with fewer injections, the researchers
note.
"Nevertheless, as
the only way of reducing microvascular disease is by maintaining tight
glycemic control, we need better ways of enabling patients to
intensify their insulin treatment," they write.
The DAFNE approach has
the potential to reduce the incidence of complications and improve
quality of life for people with type I diabetes, and deserves further
investigation, they conclude. BMJ
2002;325:746-749. =================================
