phoenix
Expert
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- Type of diabetes
- Type 1
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- Pump
The effect of carbohydrate intake on glycaemic control in patients with type 1 diabetes treated with insulin pumps
M.L James, L Green, S.A. Amiel, P Choudary
This is one of the presentations from the EASD conference. The lead researcher was an undergraduate who presented really well, I would have been scared stiff.
You an view it here
http://www.easdvirtualmeeting.org/resources/5862
'I've summarised the findings. It is just a retrospective snapshot of a group of patients at one hospital and not a randomized trial but I would say interesting results in view of some of the previous discussions on the forum. The research question is the 'million dollar question!' Obviously the findings aren't necessarily transferable to MDI
Research Question
Does carbohydrate intake (which may be high as a result of dietary freedom supported by Flexible Intensive Insulin therapy courses) affect ability to control glucose?
The hypotheses were
The subjects all used Medtronic pumps.
The vast majority had done DAFNE
. Data from the pumps on blood glucose readings, carb intake etc used for the study. They only included subjects who used the bolus wizard 80+% of the time.
A subset of the patients recorded more details of pre/postpradial glucose, CHO content and bolus
Mean HbA1c was 7.8% but there was a very wide range from 5% to 12%
Mean carb intake was 166 . The median was 158 with an interquartile range of 109-206 (that is the middle 50% so there would be 25% below and 25% above this so a broad range of carb intakes Looking at the graphs this included a handful under 50, more evenly distributed up to around 200, and a few above 300)
Results
Conclusion
Dietary freedom, as part of FIIT, remains acceptable with regards to blood glucose control
From questions:
M.L James, L Green, S.A. Amiel, P Choudary
This is one of the presentations from the EASD conference. The lead researcher was an undergraduate who presented really well, I would have been scared stiff.
You an view it here
http://www.easdvirtualmeeting.org/resources/5862
'I've summarised the findings. It is just a retrospective snapshot of a group of patients at one hospital and not a randomized trial but I would say interesting results in view of some of the previous discussions on the forum. The research question is the 'million dollar question!' Obviously the findings aren't necessarily transferable to MDI
Research Question
Does carbohydrate intake (which may be high as a result of dietary freedom supported by Flexible Intensive Insulin therapy courses) affect ability to control glucose?
The hypotheses were
- Daily carbohydrate intake and mean meal size will be positively associated with HbA1c
- Larger carbohydrate meals will result in higher post prandial glucose
The subjects all used Medtronic pumps.
The vast majority had done DAFNE
. Data from the pumps on blood glucose readings, carb intake etc used for the study. They only included subjects who used the bolus wizard 80+% of the time.
A subset of the patients recorded more details of pre/postpradial glucose, CHO content and bolus
Mean HbA1c was 7.8% but there was a very wide range from 5% to 12%
Mean carb intake was 166 . The median was 158 with an interquartile range of 109-206 (that is the middle 50% so there would be 25% below and 25% above this so a broad range of carb intakes Looking at the graphs this included a handful under 50, more evenly distributed up to around 200, and a few above 300)
Results
- This was a slight but significant negative association between carb intake and HbA1c ie the higher the daily carb intake the lower the HbA1c
- There was no association between day to day variability of carb intake and HbA1c
- More meals during the day tended to result in better glycemic control .
- On an individual meal basis , a higher carb intake in a meal has a slight but positive association with higher HbA1c
- For post prandial readings within 3 hours there was no effect of the amount of carbohydrate on the change in glucose levels.
- For post prandial readings at 5-7 hours there was a weak but positive correlation between a higher carb content and glucose levels.
Conclusion
Dietary freedom, as part of FIIT, remains acceptable with regards to blood glucose control
From questions:
- Higher carbs were associated with fewer hypos
- None used extended boluses for higher carb meals (said might be interesting to see if the use of this would mitigate the late postprandial rise.I agree)
- They didn't take into account total energy ie calorie content (as she said interesting but of course not data that is on the pump)
- There was no association between total daily carbohydrate content and BMI
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