Carbohydrate counting is recommended as best clinical practice for type 1 diabetes to achieve tight glycaemic control (1,2,3). A dietitian experienced in providing medical nutrition therapy including carbohydrate counting is employed in the Young Adult Diabetes service (YADS) at Dandenong Hospital. Dietetic intervention is provided to patients who are referred from the clinic’s health providers or are self-referred.
To review dietetic encounters and advice provided in the clinical setting and the impact of carbohydrate counting on glycaemic control in patients with type 1 diabetes.
A retrospective audit was completed of patients aged between 18 and 30 years who attended YADS at Dandenong Hospital from April 2012 to April 2014. Medical records were reviewed and data extracted on type of diabetes, medical nutrition therapy and diabetes management provided.
138 patient medical records were reviewed. 124 of these patients were diagnosed with type 1 diabetes and 108 (87%) were managed with basal bolus insulin, 13 (10%) with insulin pump therapy and three patients used pre-mixed insulin. HbA1c at initial consultation was 9.5%, with a reduction to 8.9% at the most recent appointment.
There were a total of 542 medical review appointments, and 96 dietetic appointments. 42 patients (30.4%) had dietetic appointments. 46 appointments were specifically for carbohydrate counting.
Carbohydrate counting education discussed 15g carbohydrate serves, difficult foods such as rice, pasta and potato, take away, eating out and label reading. Most patients received a single carbohydrate counting session with no evaluation of knowledge post. There was a 1.3% reduction in HbA1c in those patients who attended education in carbohydrate counting which was greater than those who did not.
The results suggest a dietitian has an important role in carbohydrate counting education to improve glycaemic control. Further research will be conducted to investigate delivery style and glycaemic outcome.