Carbohydrate counting, nutritional status and metabolic profil eof adolescents with type 1 diabetes mellitus

Abstract

AIMS: To evaluate the effect of a carbohydrate counting program on the anthropometric measurements, body composition, biochemical parameters anddietary intake of adolescentswithtype 1 diabetes mellitususing insulin. METHODS: A randomized clinical trial included adolescents between 10 and 19 years in treatment for type 1 diabetes with association of fast-acting insulin (regular) and intermediate-acting insulin (Neutral Protamine Hagedorn). The participants received nutritional counseling and were followed for four months, being divided into intervention group (IG), with carbohydrate counting, and control group (CG), without carbohydrate counting. At the beginning and end of the program, patients were evaluated for body mass index, waist circumference, body fat percentage and biochemical parameters: glycated hemoglobin, fasting glucose, postprandial glucose and lipid levels. Dietary intake was assessed every two weeks through the 24-hour recall. For intragroup comparison T-paired and Wilcoxon tests were used, and for intergroup comparison Student t and Mann-Whitney tests were used. The significance level was 5%. RESULTS: The study included 28 adolescents, 14 in each group. The IG significantly decreased glycated hemoglobin (p=0.002) and lipid intake (p=0.002), and increased carbohydrate intake (p=0.005). The CG increased glycated hemoglobin (p=0.024). The IG showed lower fasting glucose value (p=0.033) and glycated hemoglobin (p <0.001) compared to the CG. Both groups decreased caloric intake. Anthropometric parameters were stable and there was no difference between groups. CONCLUSIONS: Carbohydrate counting together with Neutral Protamine Hagedorn and Regular insulins favored glycemic control, allowed flexibility in carbohydrate intake, decreased caloric intake, and had no effect on body composition