Reach Gérard, Choleau Carine
Bull Acad Natl Med. 2013 Jan;197(1):93-102; discussion 102.
Carbohydrate counting is the most difficult component of functional insulin therapy. We thus designed a tool to facilitate carbohydrate counting of meals.
The tool consists of an illustrated directory (16 x 10 cm, 119 pages) presenting 389 pictures of food, classified in 12 categories (breads, fruits, vegetables, etc.). For each photo, the name and mode of preparation of the foods are given, with the weight of the illustrated portion and its carbohydrate content as a multiple of 5 g. During the first phase of the study (3 days a week for 12 weeks), twelve patients with type 1 diabetes completed a precise food diary using a list and weight of all consumed foods. We were thus able to determine, for each of three meals (breakfast, lunch and dinner), the variability of their carbohydrate content. During the second phase of the study (2 weeks), the patients were given the possibility of using the illustrated food directory. We asked them first to estimate, from the photos, the global carbohydrate content of their meals, and then to weigh each food. This allowed us to calculate the true carbohydrate content of the meals from nutritional tables.
During the first phase, the carbohydrate contents of breakfast, lunch and dinner were 67 +/- 29, 72 +/- 30 and 74 +/- 30 g, respectively (mean +/- SD, n = 12). For a given patient, the variability in the carbohydrate content of each meal was expressed by its standard deviation (SD). For the 12 patients, this variability was 18+/-+ 8, 25+/-+ 8 and 27+/-+ 11 g, respectively, for breakfast, lunch and dinner, and represented on the average about one-quarter of the total carbohydrate content. During the second phase, carbohydrate content, estimated by the patients using the illustrated food directory, correlated well with the retrospective evaluation based on nutritional tables (y = 0.95 x + 5 g, r2 = 0.8 ; n = 12, 235 meals).
This new illustrated food repertory allows accurate evaluation of the highly variable carbohydrate content of meals, and could thus facilitate functional insulin therapy.
碳水化合物计数是功能性胰岛素治疗中最困难的部分。因此，我们设计了一种工具来方便计算餐食中的碳水化合物含量。
该工具包括一本带插图的目录（16×10厘米，119页），展示了389张食物图片，分为12类（面包、水果、蔬菜等）。对于每张照片，给出了食物的名称和制备方式，以及所示部分的重量及其碳水化合物含量（以5克的倍数表示）。在研究的第一阶段（每周3天，共12周），12名1型糖尿病患者使用所消耗食物的清单和重量完成了一份精确的食物日记。这样我们就能确定三餐（早餐、午餐和晚餐）中每餐碳水化合物含量的变异性。在研究的第二阶段（2周），患者可以使用这本带插图的食物目录。我们首先要求他们根据图片估计餐食的总碳水化合物含量，然后称量每种食物。这使我们能够根据营养表计算餐食的实际碳水化合物含量。
在第一阶段，早餐、午餐和晚餐的碳水化合物含量分别为67±29克、72±30克和74±30克（平均值±标准差，n = 12）。对于给定的患者，每餐碳水化合物含量的变异性用其标准差（SD）表示。对于这12名患者，早餐、午餐和晚餐的这种变异性分别为18±8克、25±8克和27±11克，平均约占总碳水化合物含量的四分之一。在第二阶段，患者使用带插图的食物目录估计的碳水化合物含量与基于营养表的回顾性评估相关性良好（y = 0.95x + 5克，r2 = 0.8；n = 12，235餐）。
这本新的带插图的食物手册能够准确评估餐食中高度可变的碳水化合物含量，从而有助于功能性胰岛素治疗。
