Biting off more than you can chew: is it possible to precisely count carbohydrate?

Aim: Carbohydrate counting is used to adjust premeal insulin to carbohydrate intake in intensive insulin regimens. The aim of the present study was to determine the potential variability in the carbohydrate content of a slice of bread (one ‘exchange’) from that reported on the label and hence, the potential variability in carbohydrate intake when consuming a serve. Methods: A cross-sectional survey of 11 different loaves of bread commonly consumed by children with type 1 diabetes was undertaken. All slices in each loaf were weighed to an accuracy of ±1 g; and the reported carbohydrate content per 100 g of each loaf was used to determine the carbohydrate content of the mean, minimum and maximum slice in each loaf of bread. Results: There was no difference between the reported and the mean estimated carbohydrate content of a slice. The minimum slice of bread across all loaves was estimated to contain only 10.0 g of carbohydrate, whereas the maximum slice contained an estimated 20.7 g of carbohydrate. The greatest variation in carbohydrate amount within a loaf was 12.3 g. Conclusions: In commercially available loaves of bread in Australia, the carbohydrate content of a slice can vary by up to 45% of that reported on the label, in accordance with Food Standards Australia New Zealand. This highlights a practical limitation inherent with the commonly held view that food labels can facilitate accuracy in carbohydrate counting in 1-g increments

Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers - RESIST. A randomised control trial investigating the effects of two different diets on insulin sensitivity in young people with insulin resistance and/or pre-diabetes.

Abstract Background Concomitant with the rise in childhood obesity there has been a significant increase in the number of adolescents with clinical features of insulin resistance and prediabetes. Clinical insulin resistance and prediabetes are likely to progress to type 2 diabetes and early atherosclerosis if not targeted for early intervention. There are no efficacy trials of lifestyle intervention in this group to inform clinical practice. The primary aim of this randomised control trial (RCT) is to determine the efficacy and effectiveness of two different structured lifestyle interventions differing in diet composition on insulin sensitivity, in adolescents with clinical insulin resistance and/or prediabetes treated with metformin. Methods/design This study protocol describes the design of an ongoing RCT. We are recruiting 108 (54 each treatment arm) 10 to 17 year olds with clinical features of insulin resistance and/or prediabetes, through physician referral, into a multi-centred RCT. All participants are prescribed metformin and participate in a diet and exercise program. The lifestyle program is the same for all participants except for diet composition. The diets are a high carbohydrate, low fat diet and a moderate carbohydrate, increased protein diet. The program commences with an intensive 3 month dietary intervention, implemented by trained dietitians, followed by a 3 month intensive gym and home based exercise program, supervised by certified physical trainers. To measure the longer term effectiveness, after the intensive intervention trial participants are managed by either their usual physician or study physician and followed up by the study dietitians for an additional 6 months. The primary outcome measure, change in insulin sensitivity, is measured at 3, 6 and 12 months. Discussion Clinical insulin resistance and prediabetes in the paediatric population are rapidly emerging clinical problems with serious health outcomes. With appropriate management these conditions are potentially reversible or at least their progression can be delayed. This research study is the first trial designed to provide much needed data on the effective dietary management for this cohort. This study will inform clinical practice guidelines for adolescents with clinical insulin resistance and may assist in preventing metabolic complications, type 2 diabetes and early cardiovascular disease. Trial registration Australian and New Zealand Clinical Trials Registration Number ACTRN12608000416392</p