Gillespie S J, Kulkarni K D, Daly A E
Piedmont Clinic, Atlanta, Ga, USA.
J Am Diet Assoc. 1998 Aug;98(8):897-905. doi: 10.1016/S0002-8223(98)00206-5.
Carbohydrate counting is a meal planning approach used with clients who have diabetes that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carbohydrate counting has been around since the 1920s, but it received renewed interest after being used as 1 of 4 meal planning approaches in the Diabetes Control and Complications Trial. In the trial, carbohydrate counting was found to be effective in meeting outcome goals and allowed flexibility in food choices. Recent practice pattern surveys have shown an increasing interest in and use of carbohydrate counting for medical nutrition therapy for persons with diabetes. Carbohydrate counting can be used by clients with type 1, type 2, and gestational diabetes. Three levels of carbohydrate counting have been identified based on increasing levels of complexity. Level 1, or basic, introduces clients to the concept of carbohydrate counting and focuses on carbohydrate consistency. Level 2, or intermediate, focuses on the relationships among food, diabetes medications, physical activity, and blood glucose level and introduces the steps needed to manage these variables based on patterns of blood glucose levels. Level 3, or advanced, is designed to teach clients with type 1 diabetes who are using multiple daily injections or insulin infusion pumps how to match short-acting insulin to carbohydrate using carbohydrate-to-insulin ratios. All 3 levels emphasize portion control and offer opportunities for using creative teaching methods, such as "food labs," and use of a variety of carbohydrate resource tools and publications. In this article, glycemic effects of protein, fat, and fiber intake are discussed for persons with type 1 and type 2 diabetes. Decision trees are introduced for each level of carbohydrate counting and show the usual progression through each level. Carbohydrate counting as a meal planning approach offers variability of food choices with the potential for improving glycemic control. Research opportunities are available for those interested in comparing carbohydrate counting with other meal planning approaches for clients with diabetes and the effects on clinical outcomes.
碳水化合物计数是一种用于糖尿病患者的膳食计划方法，该方法将碳水化合物视为影响餐后血糖反应的主要营养素。碳水化合物计数的概念自20世纪20年代就已存在，但在被用作糖尿病控制与并发症试验的四种膳食计划方法之一后，重新受到关注。在该试验中，发现碳水化合物计数在实现治疗目标方面有效，并且在食物选择上具有灵活性。最近的实践模式调查显示，对于糖尿病患者的医学营养治疗，人们对碳水化合物计数的兴趣和使用正在增加。1型、2型和妊娠期糖尿病患者都可以使用碳水化合物计数法。根据复杂程度的增加，已确定了三个碳水化合物计数级别。第1级，即基础级，向患者介绍碳水化合物计数的概念，并注重碳水化合物的一致性。第2级，即中级，关注食物、糖尿病药物、身体活动和血糖水平之间的关系，并介绍根据血糖水平模式管理这些变量所需的步骤。第3级，即高级，旨在教导使用每日多次注射或胰岛素输注泵的1型糖尿病患者如何使用碳水化合物与胰岛素的比例将短效胰岛素与碳水化合物相匹配。所有三个级别都强调控制食量，并提供使用创新教学方法的机会，如“食物实验室”，以及使用各种碳水化合物资源工具和出版物。在本文中，讨论了1型和2型糖尿病患者蛋白质、脂肪和纤维摄入的血糖影响。针对每个碳水化合物计数级别引入了决策树，展示了通常的逐级进展情况。碳水化合物计数作为一种膳食计划方法，提供了食物选择的多样性，具有改善血糖控制的潜力。对于有兴趣将碳水化合物计数与糖尿病患者的其他膳食计划方法进行比较以及对临床结果影响的人来说，有研究机会。
