Carbohydrate counting and insulin bolus calculation is recommended in the management of Type 1 diabetes (NICE 2015).
Studies have looked at the effects of carbohydrate counting on indicators like HbA1c, however the currently available literature does not provide sufficient evidence to definitively determine the effects of carbohydrate counting on HbA1c.
For every 10% reduction in HbAc1 there is a marked reduction in complications over time, some evidence also suggests that the sooner this reduction occurs in the person’s life with diabetes the greater the benefits and also more cases of complications are prevented by the same degree of improvement in glycaemic control at higher levels of HbA1c.
In our study there was a mean improvement in hba1c of 7% across the whole group, which was statistically significant (p=0.005). Those patients who improved HbA1c in our study improved with a mean 18% reduction in HbA1c.
Carbohydrate counting course appears to relate to reduction in hba1c at 3 months and this reduction is maintained at 6 months post course in our service in the group.
The course was originally set up to save on the cost of purchasing a course and maintenance costs of that course.
Set up costs of £7,673.93. ongoing costs of £308 for patient registration £3872 per year admin from DAFNE. We have had 2 trainers leave and be replaced in the last 6 years which would have been an additional £7,673.93 to train up.
In total we have saved approx £15,000 in establishing our own course and also save £4000 per year.
So although carb counting is not a new way of working we were one of the first centres in the north west to establish our own carb counting course and more people pass through our course than others locally.
We take referrals not just from our service but also from other Trusts.
Most of all the patients who do the course enjoy it so much and I enjoy it too.
Currently it is delivered by a senior diabetes nurse and a senior diabetes dietitian. We are looking at delivering a carb refresher course which will be the first one in this area however we are struggling with admin time and our time to finalise the course due to clinical pressures but once up and running hopefully this will be as successful