Pediatric Diabetology, University Hospital, Angers, France.
Pediatric Diabetology, University Hospital, Tours, France.
Pediatr Diabetes. 2020 Nov;21(7):1240-1248. doi: 10.1111/pedi.13076. Epub 2020 Aug 3.
The effect of advanced carbohydrate counting (ACC) on metabolic and quality of life (QOL) outcomes is uncertain in children with type 1 diabetes. Our aim was to determine whether ACC would improve HbA1c and QOL scores as compared with standard nutrition in this population.
We randomized 87 patients using pump and rapid-acting analogs in a 1 year randomized multicenter study (age 9.6 ± 3.5 years, diabetes duration 4.6 ± 2.7 years, HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]). The ACC group received CC education and the control group received traditional dietary education. HbA1c was measured every 3 months. At 0 and 1 year, general, diabetes-specific, and diet-related QOL were respectively assessed by the KIDSCREEN and WHO-5 questionnaires, the diabetes-specific module of the DISABKIDS, and the diet restriction items of the DSQOLS.
Mean HbA1c was lower in the ACC than the control group at 3 months (P < .05) and tended to be lower at 6 months (P = .10), 9 months (P = .10), but not at 12 months. The mean of individual average HbA1c during the one-year study period (from M3 to M12) was 7.63 ± 0.43 in the ACC vs 7.85 ± 0.47% in the control group (60 ± 5 vs 62 ± 5 mmol/mol)(P < .05). ACC was associated with significantly higher scores at 1 year on the KIDSCREEN children's psychological scale and the KIDSCREEN parents' physical scale, the DISABKIDS children's treatment scale, and the children's and parents' dietary restriction scales of the DSQOLS (indicating better QOL or lower perceived diet restriction).
ACC may be associated with small improvements in metabolic control and QOL scores in children.
在 1 型糖尿病儿童中，高级碳水化合物计数 (ACC) 对代谢和生活质量 (QOL) 结果的影响尚不确定。我们的目的是确定在该人群中，与标准营养相比，ACC 是否会改善 HbA1c 和 QOL 评分。
我们对 87 名使用泵和速效类似物的患者进行了为期 1 年的随机多中心研究（年龄 9.6 ± 3.5 岁，糖尿病病程 4.6 ± 2.7 年，HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]）。ACC 组接受 CC 教育，对照组接受传统饮食教育。每 3 个月测量一次 HbA1c。在 0 和 1 年时，分别使用 KIDSCREEN 和 WHO-5 问卷、DISABKIDS 的糖尿病特异性模块和 DSQOLS 的饮食限制项目评估一般、糖尿病特异性和饮食相关的 QOL。
在 3 个月时，ACC 组的平均 HbA1c 低于对照组（P <.05），并且在 6 个月（P =.10）、9 个月（P =.10）时也有降低趋势，但在 12 个月时没有降低。在为期一年的研究期间（从 M3 到 M12），ACC 组的平均个体平均 HbA1c 为 7.63 ± 0.43%，而对照组为 7.85 ± 0.47%（60 ± 5 vs 62 ± 5 mmol/mol）（P <.05）。ACC 与 1 年后 KIDSCREEN 儿童心理量表和 KIDSCREEN 父母身体量表、DISABKIDS 儿童治疗量表以及 DSQOLS 的儿童和父母饮食限制量表上的评分显著升高相关（表明 QOL 更高或感知饮食限制更低）。
ACC 可能与儿童代谢控制和 QOL 评分的微小改善相关。
