Basal/Bolus Therapy Using Carb Counting Very Effective In Lowering A1c

Two effective approaches to delivering and adjusting rapid-acting mealtime insulin for people with type 2 diabetes. Adjusting insulin dose using a carbohydrate ratio was compared to a therapy using a simple alogorithm. Carbohydrate counting is an effective approach to mealtime insulin adjustment in type 1 diabetes but has not been rigorously assessed in type 2 diabetes. The researchers from the USA sought to compare an insulin-to- carbohydrate ratio with a simple algorithm for adjusting the dose of prandial insulin glusiline. This 24-week, multicenter, randomized, controlled study compared two algorithms for adjusting mealtime (glulisine) insulin along with a standard algorithm for adjusting background (glargine) insulin in 273 intent-to-treat patients with type 2 diabetes. Glulisine and glargine were adjusted weekly in both groups based on self- monitored blood glucose (SMBG) results from the previous week. The simple algorithm group were provided with set doses of glulisine to take before each meal. The carbohydrate counting (carb count) group was provided an insulin-to- carbohydrate ratio to use for each meal and adjusted their glulisine dose based on the amount of carbohydrate consumed.

A1C levels at week 24 were 6.70% (simple algorithm) and 6.54% (carb count). The respective mean A1C changes from baseline to 24 weeks significantly were -1.46 and -1.59%. A1C <7.0% was achieved by 73.2% (simple algorithm) and 69.2% (carb count) of subjects; respective values for A1C <6.5% were (significantly) 44.3 and 49.5%. The total daily dose of insulin was lower, and there was a trend toward less weight gain in carb count group patients. Severe hypoglycemia rates were low and equal in the two groups.

The researchers concluded: "Weekly basal-bolus insulin adjustments based on premeal and bedtime glucose patterns resulted in significant reductions in A1C. Having two effective approaches to delivering and adjusting rapid-acting mealtime insulin may increase physicians’ and patients’ willingness to advance therapy to a basal-bolus insulin regimen."

Both methods are helpful for a disorder where often patients and sometimes doctors are reluctant to initiate insulin therapy

Diabetes Care March 2008 31:1305-1310, 2008 : Adjust to Target in Type 2 Diabetes: Comparison of a simple algorithm with carbohydrate counting for adjustment of mealtime insulin glulisine. Richard M. Bergenstal, MD, Mary Johnson, RN, CDE, Margaret A. Powers, PHD, RD, CDE et al.

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FACT:

Daily Glass of Juice Raises Diabetes Risk: Drinking a glass of fruit juice daily could increase the chances of development of type 2 diabetes among women.  Researchers in the United States discovered that women who drink a glass of fruit juice every morning may be 18 per cent more likely to get type 2 diabetes. However, in contrast, consumption of green leafy vegetables and whole fruit was associated with a lower hazard of diabetes. The study, which involved case studies of 71,346 female nurses between 38 years and 63 years, started research on these women in 1984 and they followed for 18 years. The findings of the study, revealed that natural sugars in fruits could potentially be damaging when consumed in form of juice. During follow-up, 4,529 cases of diabetes were documented, and the cumulative incidence of diabetes was 7.4 per cent. An increase of three servings per day in total fruit and vegetable consumption was not associated with development of diabetes   Diabetes Care, July 2008