Impact of advanced and basic carbohydrate counting methods on metabolic control in patients with type 1 diabetes.

Objective: Diets based on carbohydrate counting remain a key strategy for improving glycemic control in patients with type 1 diabetes. However, these diets may promote weight gain because of the flexibility in food choices. The aim of this study was to compare carbohydrate counting methods regarding anthropometric, biochemical, and dietary variables in individuals with type 1 diabetes, as well as to evaluate their knowledge about nutrition.

Methods: Participants were allocated in basic or advanced groups. After 3 mo of the nutritional counseling, dietary intake, anthropometric variables, lipemia, and glycemic control were compared between groups. A questionnaire regarding carbohydrate counting, sucrose intake, nutritional knowledge, and diabetes and nutrition taboos also was administered.

Results: Ten (30%) participants had already used advanced carbohydrate counting before the nutritional counseling and these individuals had a higher body mass index (BMI) (P < 0.01) and waist circumference (WC) (P = 0.01) than others (n = 23; 69.7%). After 3 mo of follow-up, although participants in the advanced group (n = 17; 51.52%) presented higher BMI (P < 0.01) and WC (P = 0.03), those in the basic group (n = 16; 48.48%) showed a higher fat intake (P < 0.01). The majority of participants reported no difficulty in following carbohydrate counting (62.5% and 88% for basic and advanced groups, respectively) and a greater flexibility in terms of food choices (>90% with both methods).

Conclusions: Advanced carbohydrate counting did not affect lipemic and glycemic control in individuals with type 1 diabetes, however, it may increase food intake, and consequently the BMI and WC, when compared to basic carbohydrate counting. Furthermore, carbohydrate counting promoted greater food flexibility.