Value of carbohydrate counting

The International Diabetes Federation’s Diabetes (IDF) Atlas Reports 2022 recently published the 10 countries with the highest prevalence of type 1 diabetes for all ages: the USA (highest), India, Brazil, China, Germany, the UK, Russia, Canada, SA and Spain.2 Not only do we as a global nutrition and prevention community have a huge burden to mitigate, but we need more effective tools to help people living everyday with diabetes self-manage this chronic condition better. Since the Diabetes Control and Complications Trial,3 we have known CC is beneficial, particularly for those with type 1 diabetes,4 and it is the currently recommended nutrition approach alongside continuous blood glucose monitoring or self-monitoring of blood glucose via finger stick, as it has the biggest effect on postprandial glucose excursions.5 Evaluating the implementation and accuracy of CC in daily life among persons living with type 1 diabetes adds some important information to this puzzle from a less-well studied area of our global community. Barriers include but are not limited to access to dietitians with real-world diabetes teaching experience, patient–provider communication, cultural comfort with the health care team, transportation to appointments, out-of-pocket costs for healthcare professional visits, access to healthy food options, ability to take time away from work and health-literacy and numeracy-literacy skills. Some have proposed embracing technology to help us get better at counting the carbohydrates, sometimes with limited success.16 17 The use of the effective health literacy-based teaching style, ‘teach-back’, promoted by the American Heart Association, the American Diabetes Association, Association of Diabetes Care and Education Specialists, American Nurses Association and other health care professions,18–20 was not reported by Bawazeer et al1 ‘Teach-back’ is frequently used by nurses, but less so by dietitians and the international use of ‘teach-back’ among dietitians is even less well studied.20 A tool such as C-O-U-N-T C-A-R-B-S,21 developed for nurses and other non-dietitians, could be more widely adopted as a patient-centred, literacy-based approach to reinforcing CC concepts taught by dietitians. Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR).