Simplifying carb counting: A randomized controlled study - Feasibility and efficacy of an individualized, simple, patient-centred carb counting tool

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Simplified Meal Management in Adults Using an Advanced Hybrid Closed-Loop System

Background: The advanced hybrid closed-loop (AHCL) algorithm combines automated basal rates and corrections yet requires meal announcement for optimal performance, which poses a challenge for some. We aimed to compare glucose control in adults with type 1 diabetes (T1D) using the MiniMedTM 780G AHCL system, utilizing simplified meal announcement versus precise carbohydrate (CHO) counting. Methods: In a study involving 14 adults with T1D, we evaluated glycemic control during a 13-week "precise phase," followed by two 3- to 4-week simplified meal announcement phases: "fixed one-step" (preset of one personalized fixed CHO amount) and "multistep" (entry of multiples of one, two, or three of these presets depending on meal size estimate). Results: The mean age was 45.7 ± 12.4, and 10 participants were male (71%). Mean baseline HbA1c was 6.8% ± 1.2% and time in range (TIR) was 67.5% ± 16.7%. Comparing the fixed one-step to the precise study phase, TIR was similar (75.4 ± 13% vs. 77.7 ± 9%, P = 0.12), and glucose management indicator (GMI) was slightly higher (6.8 ± 0.4 vs. 6.6 ± 0, P = 0.01). Furthermore, there was less level 1 and 2 hypoglycemia (1.6 ± 1% vs. 2.8 ± 2%, P = 0.03 and 0.3 ± 5% vs. 0.65 ± 1%, P = 0.08) but slightly more level 1 and 2 hyperglycemia (17.1 ± 8% vs. 15.0 ± 7%, P = 0.05 and 5.5 ± 5% vs. 3.6 ± 3%, P = 0.04). When comparing the multistep with the precise phase, GMI was identical (6.6%) and TIR superior (80.5 ± 10% vs. 77.7 ± 9%, P = 0.02). Additionally, there was less level 1 hypoglycemia (1.9 ± 1% vs. 2.8 ± 2%, P = 0.01) and a trend for less level 2 hypoglycemia (0.4 ± 0.7% vs. 0.65 ± 1%, P = 0.08). Conclusions: A simplified meal announcement strategy for adults using the MiniMed 780G system, relying on three increments of a fixed one-step CHO amount, may offer a way to improve glycemic control and ease self-care. For patients with more limitations, using one fixed one-step CHO amount could be a safe alternative to meeting most consensus glycemic targets.

Carbohydrate Counting: A Bibliometric Analysis with a Focus on Research

Diabetes is a metabolic disease characterized by hyperglycemia due to impaired insulin secretion, activity, or both. Carbohydrate counting, known for optimal metabolic control, plays in the therapeutic strategy in diabetes. In the last decade, an increasing amount of research has been conducted on carbohydrate counting, and the literature on this topic has been published in academic journals. This bibliometric analysis aimed to comprehensively review and analyze publications from this period, shedding light on trends, developments, and key contributors. The Expanded Science Citation Index published by the Institute for Scientific Information Web of Science, which covers English-language articles published from 1993 to 2024, was used. We selected "carbohydrate counting", "carbohydrate count", "carbohydrate counts", "carbohydrate counts", and similar words as "TOPIC" to search for related articles. All basic information about each article were collected, including authors, countries, citations, and keywords. The findings emphasized the need for continued research in this area and to learn more about studies showing the relationship between carbohydrate counting and the pathophysiology of diabetes, treatment, complications, and technologies. This analysis summarizes the general trends and key findings of research on carbohydrate counting over the past years and provides guidance for future research.

Basic carbohydrate counting and glycemia in young people with type 1 diabetes in India: A randomized controlled trial

OBJECTIVES

The aim of this study was to evaluate the effect on glycemic control and acceptability of basic carbohydrate counting (BCC) in children and young adults with type 1 diabetes (T1DM).

METHODS

Ninety-two children and young adults (6-25 y of age) with T1DM were randomized to receive either routine nutrition education (RNE), which addressed food groups, glycemic index, and effects of food and exercise on glycemia, or learn BCC with personalized portion size education. A continuous glucose monitoring study and glycosylated hemoglobin (HbA1c) were performed at baseline and after 12 wk. The primary outcome was a change in time-in-range from baseline through 12 wk. A questionnaire on the acceptability of BCC was administered.

RESULTS

At 12 wk, there was no significant difference in change in time-in-range between the two groups (BCC group: 1.2 ± 12.2; RNE group: 1.9 ± 12.3; P = 0.786). No significant changes were observed in the percentage of time that blood glucose was >180 or >250 mg/dL; <70 or <54 mg/dL; glycemic variability, percentage of nights with hypoglycemia and HbA1c. In subgroup analysis, there was a significant decrease in HbA1c in the BCC group among participants with higher maternal education (-0.5 versus 0.2, P = 0.042). The total score on the acceptability questionnaire was higher in the BCC group (P = 0.022).

CONCLUSION

Among children and young adults in our region with T1DM, BCC provided flexibility in food choices and perception of greater ease of insulin adjustment. Although BCC was equivalent to RNE in terms of glycemic control, larger studies may reveal benefit in outcomes in certain subgroups.

Real-world evidence study finds no new-onset diabetes or drug-related hyperglycemia in Pompe disease patients treated with avalglucosidase alfa

Avalglucosidase alfa therapy for Pompe disease is diluted in dextrose 5% solution in water (D5W) for infusion, which raises questions about the potential for hyperglycemia or worsening diabetes. Using United States insurance claims data, we assessed the impact of biweekly infusions on hyperglycemia, new-onset diabetes mellitus, insulin resistance, and prediabetes in patients with Pompe disease. After starting avalglucosidase alfa treatment, 1 of 26 patients had one claim for hyperglycemia, which was attributed to acute pancreatitis.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.