Effectiveness Of Carbohydrate Counting In Type 1 Diabetes Mellitus:a Systematic Review And Meta-analysis

Objective: Potential benefits of carbohydrate counting(CHO)for glycaemic control in patients with type 1 diabetes remain inconclusive.The aim of our study is to systematically assess the efficacy of carbohydrate counting in people with type 1 diabetes.Methods: For this updated systematic review and meta-analysis,we searched Pub Med,EMBASE,Web of Science,Cochrane Library and the China Biology Medicine(CBM).Randomized controlled trials(RCTs)with at least 3 months?follow-up that evaluated carbohydrate counting compared with usual or other diabetes dietary education in patients with type 1 diabetes were included.The primary outcome was the change in glycosylated hemoglobin(Hb A1c)concentration,secondary outcomes including the change in hypoglycemia events,insulin doses and BMI.The standardized mean difference(SMD)with corresponding 95 % confidence interval(CI)were calculated to estimate the efficacy of carbohydrate counting in people with type 1 diabetes.Results: Ten studies involving 773 patients were ultimately included in this meta-analysis,among ten included studies,five compared the carbohydrate counting with other diabetes diet method,the others compared the carbohydrate counting with usual diabetes dietary education and care.Overall meta-analysis identified a significant decrease in Hb A1 c concentration with carbohydrate counting versus other diabetes diet method or usual diabetes dietary education(SMD:-0.35,95%CI:-0.65 to-0.05,P=0.023),While there is significant heterogeneity between studies(I2 = 71.2%,P <0.001).Subgroup analysis found that there was a significant decrease in Hb A1 c concentration with carbohydrate counting versus usual diabetes dietary education and care(SMD:-0.68,95%CI:-0.98 to-0.38,P=0.000),and a similar result has emerged from five studies in adults(SMD:-0.40,95%CI:-0.78 to-0.02,P=0.037).There is no publication bias was observed(Funnel plot: P=0.929,Egger?s: P = 0.708).Compared with other diabetes diet method or usual diabetes dietary education,carbohydrate counting did not significantly reduce the hypoglycaemia events(SMD:-0.14,95%CI:-0.39 to 0.10,P=0.254;I2=0.0%,P=0.758),insulin dosage(SMD: 0.04,95%CI:-0.24 to 0.31,P=0.788;I2=0.0%,P=0.945)or BMI(SMD:-0.06,95%CI:-0.39 to 0.28,P=0.749;I2=0.0%,P=0.328)。Conclusion: Carbohydrate counting may confer positive impact on glucose control.Larger clinical trials are warranted to validate this positive impact.