Abstract

Background: Carbohydrate counting is a tool that helps patients with type 1 diabetes (T1D) to control their blood glucose. It calculates the bolus insulin dose needed from the total amount of carbohydrates consumed at each meal. However, carbohydrate counting can be quite challenging. The Diabetes Tele Management System® (DTMS®) is a telemedicine-based program that enables the patient to interact directly with a professionally trained, multidisciplinary team (MDT) of experts. This, along with technology-enabled education programs, could allow people with T1D to achieve glycemic control.

Methods: Fifty patients with T1D between 5 and 35 years with a diabetes duration of at least 6 months, baseline HbA1c of 7 or above, using SCII or MDI and willing to take part in the study were invited to participate in an MDT-assisted technology-enabled program and trained trimonthly on carbohydrate counting. The control group went on to perform carbohydrate counting independently and used technologies at their convenience. The test group additionally received continuous individual assistance from the MDT.

Results: The MDT-assisted patients had significantly decreased HbA1c, blood glucose levels, decreased episodes of hyperglycemia and hypoglycemia, and reported a more positive outlook on life.

Conclusion: Carbohydrate counting remains a challenge for youth with T1D, and errors in counting can have a clinical impact. Our data suggested that the assistance from an MDT of experts was associated with improved carbohydrate counting, which led to improved glycemic control and reduced complications.

Keywords: Carbohydrate counting, diabetes management, glycated hemoglobin, insulin, type 1 diabetes, telemedicine.