P-30: Structured carbohydrate counting with individualized insulin adjustment and glycemic outcomes in children with type 1 diabetes: a prospective cohort study from India
M Maheshwari, M Darshan, K Swarnkar, P SaliqAbstract
Introduction
Type 1 diabetes requires lifelong insulin, nutrition management, and education. Carbohydrate counting (CC) is a key strategy for intensive care, but its use in LMICs, including India, is limited. This study evaluated the impact of structured CC education on glycemic control, metabolic outcomes, and caregiver knowledge in Indian children with T1DM.
Objectives
• Change in HbA1c at 6 months •Hypoglycemia frequency • Total daily insulin dose • Carbohydrate counting knowledge score (validated 30-item tool)
Methods
A single-arm prospective interventional study included 33 children (6–18 years) with T1DM ≥1 year on basal–bolus therapy. Baseline clinical, biochemical, and anthropometric data were collected, followed by a structured, expert-validated carbohydrate counting (CC) education delivered in two interactive sessions. Individual insulin-to-carbohydrate ratios and sensitivity factors were calculated. Outcomes (HbA1c, lipid profile, hypoglycaemia, hospitalizations, and CC knowledge) were reassessed at 6 months. Data were analysed using paired t-test or Wilcoxon test, with p < 0.05 considered significant.
Results
Mean HbA1c fell from 13.29 ± 2.41% to 10.76 ± 2.34% (Δ −2.53%; 95% CI −3.31 to −1.75; p < 0.001; Cohen’s d ≈ 1.05), indicating a large improvement. Daily carbohydrate intake decreased (p < 0.001), with improved LDL and VLDL. Hypoglycaemia frequency declined (Δ −12.85 days/6 months; 95% CI −18.9 to −6.8; p < 0.001; d ≈ 0.75). Hospital admissions reduced from 0.45 ± 0.67 to 0.09 ± 0.29 (Δ −0.36; 95% CI −0.58 to −0.14; p = 0.002). CC knowledge score improved from 21.2 ± 2.8 to 23.3 ± 2.1 (Δ +2.1; 95% CI 1.2–3.0; p < 0.001; d ≈ 0.85). Change in CC score correlated inversely with HbA1c (r = −0.50; p = 0.003).
Conclusions
Structured CC education integrated with individualized insulin adjustment is feasible and associated with improved glycemic outcomes in children with T1DM in a resource-constrained setting. Larger controlled studies are required to confirm these findings and establish long-term effectiveness.