Use of advanced carbohydrate counting and an automated bolus calculator in clinical practice: the BolusCal® training concept

Abstract

Abstract Background: BolusCal® is a newly developed training concept for patients with Type 1 diabetes (T1D) on a basal-bolus regime. The training, which is provided by a diabetes nurse and a dietician, consists of a 4-hour group session followed by a 1-hour follow-up and includes training in advanced carbohydrate counting and the use of an automated bolus calculator. Aims: The aim of this article is to describe the BolusCal training concept and to report changes in HbA1c and body mass index (BMI) as well as resources spent 12 months after implementing the BolusCal training concept in routine clinical practice. Methods: During 14 months in 2012–2013, 86 patients with T1D participated in a BolusCal training course. We retrospectively collected patient data from electronic medical records. Results: From training course participation to 12 months, HbA1c decreased from 66 to 57 mmol/mol (8.2–7.4%) (p < 0.001). BMI did not change. Within the first 6 months the number of follow-up consultations ranged from 0 to 9 (median 3). Conclusions: Our newly developed training concept for patients with T1D has been successfully implemented in routine practice. Twelve months after the training, patients achieved significant and clinically relevant improvements in HbA1c whereas BMI remained stable. In general, patients needed only few follow-up consultations. Following our initial positive experience with the BolusCal training concept, we are now training other health care professionals in providing the training concept to T1D patients within Denmark and throughout Europe.