Carbohydrate counting and insulin analogs to treat type 1 diabetes mellitus. How to improve metabolic control?

IF 2.8 4区医学 Q1 PEDIATRICS Jornal de pediatria Pub Date : 2024-03-01 DOI:10.1016/j.jped.2023.10.003

Amanda Maria Barradas Monteiro de Santana, Nathália Azevedo, Raphael Del Roio Liberatore Junior

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Abstract

Objectives

Clinical-laboratory comparison of a population of children and adolescents with DM1 followed at a Brazilian outpatient university clinic, at two different periods (2014 and 2020), regarding changes made both to the insulin therapy scheme and to the nutritional approach to carbohydrate counting.

Methods

The data of patients with DM1 aged 0–19 years enrolled in the service in 2014 and 2020 were collected. Student's t-test was performed to compare the means of HbA1c and the variables of interest.

Results

NPH + regular insulin was predominantly used in 2014 (49.1%), while in 2020, the predominance shifted to insulin analogs (48.4%). Pump use tripled from 1.3% in 2014 to 4.4% in 2020, and the percentage of patients performing carbohydrate counting reduced from 28.3% to 17.8%. Regarding HbA1c, the 2014 group of patients had a mean of 9.8%, while the 2020 group had a mean of 9.6% (p = 0.49).

Conclusion

The change in treatments between 2014 and 2020 did not result in a significant improvement in HbA1c levels. However, it was identified the importance of carbohydrate counting and the use of insulin analogs to improve metabolic control in this population at both times.

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碳水化合物计数和胰岛素类似物治疗1型糖尿病。如何改善代谢控制？

目的：对巴西一所大学门诊诊所在两个不同时期（2014年和2020年）随访的DM1儿童和青少年群体的临床实验室比较，了解胰岛素治疗方案和碳水化合物计数的营养方法的变化。方法：收集2014年和2020年参加该服务的0-19岁DM1患者的数据。进行Student t检验以比较HbA1c的平均值和感兴趣的变量。结果：NPH + 2014年主要使用常规胰岛素（49.1%），而在2020年，主要使用胰岛素类似物（48.4%）。泵的使用量从2014年的1.3%增加到2020年的4.4%，增加了两倍，进行碳水化合物计数的患者比例从28.3%减少到17.8%。关于HbA1c，2014年患者组的平均值为9.8%，而2020年患者组平均值为9.6%（p = 0.49）。结论：2014年至2020年间治疗的变化并未导致HbA1c水平的显著改善。然而，已经确定了碳水化合物计数和使用胰岛素类似物在这两个时期对改善该人群代谢控制的重要性。

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来源期刊

Jornal de pediatria 医学-小儿科

CiteScore

5.60

自引率

3.00%

发文量

审稿时长

43 days

期刊介绍： Jornal de Pediatria is a bimonthly publication of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP). It has been published without interruption since 1934. Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health.