P-472: Carbohydrate counting and glycemic control in pediatric type 1 diabetes: a cross-sectional study from a public diabetes center
A S M F da Costa, A d R P Mulder, A d A P da Silva, C A V A de VasconcellosAbstract
Introduction
Carbohydrate counting (CC) is a key nutritional approach for people with type 1 diabetes (T1D), enabling flexible dietary management by adjusting insulin doses based on meal carbohydrate intake. Guidelines emphasize monitoring carbohydrate intake as crucial for achieving optimal glycemic control in children and adolescents with diabetes.
Objectives
To compare HbA1c between youths who practice CC and those using fixed insulin doses at mealtimes, and to examine the link between the duration of CC and glycemic results.
Methods
This retrospective, cross-sectional study examined electronic medical records of pediatric and adolescents with T1D who were monitored at a tertiary Diabetes center from 2024 to 2025.
Results
Sixty-seven pediatric and adolescent patients with T1DM were evaluated, with a mean age of 11,7 ± 3,8 years and a diabetes duration of 5 years (IC 3–6). CC was practiced by 13 participants (19.4%), while 54 (80.6%) used fixed insulin dosing. Patients practicing CC had significantly lower HbA1c than those on fixed dosing, with averages of 8.2 ± 1.8% versus 9.8 ± 2.3% (p=0.011). The rate of patients reaching the target HbA1c (≤7%) was notably higher in the CC group (50% vs 17%; OR=4.67; p=0.028). Among CC users, the mean period of implementation was 12,8 ± 11,5 months, and there was an inverse relationship between the duration of strategy implementation and HbA1c levels (r = -0.56; p = 0.05), indicating improved glycemic control with increasing experience.
Conclusions
CC improves glycemic control in children and adolescents with T1D. The positive association between greater experience with this nutritional approach and improved control suggests that ongoing practice and skill refinement can enhance its effectiveness. Nevertheless, the low adoption rate remains a concern. It emphasizes the importance of improving educational resources and providing multidisciplinary support to encourage wider adoption of this evidence-based strategy.