The Effect of Basic Carbohydrate Counting on HbA1c in Type 2 Diabetic Patients: A Non-Randomized Controlled Trial

Hamide Vural, Arzu Uzuner, Pemra C. Unalan, Hayal Özkan Sınav

Keywords: type 2 diabetes mellitus, carbohydrate counting, basic carbohydrate counting, self-management, primary care

Background:
Carbohydrate counting (CC) is considered as a medical nutrition therapy method especially used in Type 1 DM (T1DM) patients in basic and advanced levels. Limited number of studies reported that basic CC improves glycemic control in T2DM patients, and there is need for further studies.

Research questions:
How the basic CC effects HbA1c levels in T2DM patients using oral antidiabetic drugs, when presented as a component of nutrition education by primary care physicians.

Method:
The study hereby is a non-randomized controlled clinical trial. T2DM patients, aged between 18-75 years, HbA1c levels between 6.5%-10.8% using oral antidiabetic medication, were followed for three months in two groups; one intervention (IG) (n=33) and one control group (CG) (n=45), in two different Primary Care Centers. General diabetes monitoring principles were applied in both groups; basic CC training was given additionally to the IG. The training consisted of three sessions lasting 40 minutes each. An informative CC booklet was provided to both groups. Beside sociodemographic questionnaire, a healthy nutrition information scale was applied to all of the participants; HbA1c, other laboratory and anthropometric measurements were performed at the beginning and at the 3rd month of the study.

Results:
The mean age value was 54.58±9.69 (28-73). Male/female distribution was (IG:57.6%/42,4%, CG:53.3%/46,7%). At the third month, HbA1c value decreased within the IG from 7.7% to 7.2% (p:0.002), from 7.49% to 7.46%, in the CG (p:0.851). Comparing two groups, the decrease in HbA1c in the IG was higher than in the CG (-0.5, -0.02, p: 0.018). Third month knowledge score was higher the intervention group’s (<0.001).

Conclusions:
Basic CC training provided to T2DM patients by primary care physician, improves glycemic control by increasing CC knowledge level and improving HbA1c.

Points for discussion:
How to integrate basic CC education at the diabetes management primary care centers?