Title:  Carb Counting And its Effect on Blood Sugars Using a New Innovative Tool

Author: Joffe, DJ, djoffe@tampabay.rr.com; Freed, SH, diabetesincontrol@home.com

Source: Diabetes In Control Newsletter, Issue 70 (1) : 12-18 2001 Sept

Abstract:

OBJECTIVE:

Education for self-management is the best way to control diabetes, improve quality of life and prevent complications.

The American Diabetes Association’s new Nutrition Recommendations for People with Diabetes Mellitus1 emphasizes carbohydrate counting as the preferred method of good diabetes management.  People are less restricted in their diets when they can match the carbohydrates in their food with the correct amount of insulin.  Carbohydrate is the food component that most affects blood glucose.  The blood glucose rise after eating is not as dependent on the form of carbohydrate but the total amount of carbohydrate consumed.  Learning to count carbs can increase good control of blood glucose, which results in a lower HbA1c and fewer complications.  Carb Cards® can make carb counting less complicated.  Carb Cards® is a set of 54 flashcards with food illustrations, portion sizes and their carbohydrate values in grams.  The set uses 54 commonly eaten foods and six blanks cards to customize.

By reducing the HbA1c (Average Blood Glucose) 1%, the DCCT study showed Type 1 diabetics could reduce the complications of Retinopathy by 38%, Nephropathy by 28% Neuropathy by 35%2. The UKPDS3 showed that by reducing the HbA1c in Type 2 diabetics by 0.9% you could reduce any diabetic end point by 12%, reduce any Microvascular end point by 25%, reduce MI by 16%, reduce Retinopathy by 21% and reduce microalbuminurea at 12 years by 34%.

The UKPDS also showed that Postprandial (blood glucose 1-2 hours after eating) glucose is a better indicator of glycemic control than fasting glucose levels4. Treatment of postprandial hyperglycemia is critical to achieving optimal outcomes in type 2 diabetes5.

 METHODS: 

We started with 30 patients with Type 1 or Type 2 diabetes.  The Carb Cards® were supplied to each patient. 

21 patients completed the study. Their pre-study  averages were fasting glucose(153 mg/dl) and postprandial blood glucose(196 mg/dl), and a base HbA1c of (8.6%) 

The educators were to spend at least 1 hour with the patients teaching them how to use the Carb Cards® and developing a plan of the amount of carbohydrates needed each day with goals that are appropriate for each individual.    

RESULTS: 

Seventy percent of the participants completed the study.  After the 90 days of using the Carb Cards®, mean daily preprandial plasma glucose concentrations were 6%(153 vs 143mg/dl) percent lower.

The usage of the Carb Cards®, lowered the 2-hour post prandial plasma glucose concentrations, by 14 percent (196 vs 168mg/dl). The usage of the Carb Cards®, lowered HbA1c from 8.6% to 8.2% (0.4% decrease).  

In the subset of patients under 18 years results were even better with average preprandial glucose dropping 8% and average Postprandial dropping 21%. HbA1c decreased 0.6%.  

In addition, each educator completed a post-use survey, to evaluate their patient’s knowledge base. 

Results were as follows: 

Improvement in Nutritional Understanding:  please rate on scale of 1 to 10 (ten is best)

Prior to Carb Cards® use  5.3

Post Carb Cards® use       8.1  

Knowledge of carbohydrate and relationship to glucose levels

Prior to Carb Cards® use  4.8

Post Carb Cards® use       6.7  

Understanding of relationship of insulin to carbohydrates

Prior to Carb Cards® use  6.3

Post Carb Cards® use       8.7  

How well did Carb Cards help the patient keep their plan and reach the goals

Prior to Carb Cards® use  4.1

Post Carb Cards® use       8.8  

CONCLUSIONS: 

As can be seen from the data above, the use of Carb Cards® in all patients with diabetes has a positive result. In addition the use of Carb Cards®  in patients younger than 18 years is even more critical. It appears that the largest effect occurs from decrease of post prandial glucose levels, which is consistent with the benefits of meal planning and carbohydrate counting.  The consistent use of the Carb Cards® appears to improve glycemic control  in patients with type 2 diabetes. Reducing postprandial blood glucose significantly caused a decrease of HbA1c, therefore reducing the complications from diabetes. 1,2,3,4,5 

For information on how you can get Carb Cards for your patients, click here: 

1Volume 24 Supplement 1 American Diabetes Association:Clinical Practice Recommendations 20012- The New England Journal of Medicine -- September 30, 1993 -- Vol. 329, No. 14-DCCT research group, Diabetes 95;44:969-983; 3- Hawaii Med J 2000 Jul;59(7):295-8, 313; BMJ. 2000 Aug 12;321(7258):405-12. 4. Harris et al. Diabetes Care. 1994. 5- De Veciana et al. N Engl J Med. 1995;333:1239