Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis

Abstract Objective: This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). Materials and methods: We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: −0.49 (-0.85, −0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. Conclusion: The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.

摘要 研究目的：本研究旨在评估碳水化合物计数法（Carbohydrate Counting, CHOC）用于治疗成人1型糖尿病（DM1）的有效性与安全性。材料与方法：本研究对比较成人1型糖尿病患者采用CHOC与一般饮食指导的随机对照研究进行了系统评价。主要结局指标为糖化血红蛋白（HbA1c）变化、生活质量及严重低血糖发作情况。我们检索了以下电子数据库：Embase、PubMed、Lilacs及Cochrane对照试验中心注册库。采用推荐分级、评估、制定与评价系统（GRADE）对证据质量进行分析。结果：本研究共检索到3190篇文献，由2名评价者独立筛选文献标题与摘要。在15项符合初步纳入标准的研究中，最终纳入5项，排除10项，原因为未采用随机分组或对照/干预组设置不同。荟萃分析结果显示，CHOC组患者的最终糖化血红蛋白水平显著低于对照组（随机效应模型均数差，95%置信区间：−0.49（−0.85, −0.13），p=0.006）。针对严重低血糖事件与生活质量的荟萃分析未显示两组间存在显著差异。根据GRADE评级，严重低血糖事件、生活质量及糖化血红蛋白变化的证据质量分别为低级别、极低级与中级别。结论：荟萃分析结果支持采用CHOC管理1型糖尿病，但该获益仅体现在最终糖化血红蛋白水平上，CHOC组患者的最终糖化血红蛋白水平显著低于对照组。