الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 155 |  |  |
| | | from | 155 | | |
Abstract
Diabetes mellitus is the most common endocrine metabolic disorder in childhood and adolescence. Currently, carb counting is a nutritional strategy that allows a greater adherence to dietary management and consumption of a greater variety of foods for patients with DM. It also requires greater adherence by the patient to maintain an adequate blood glucose monitoring and the ability to determine the amount of carbohydrates in the meals. Therefore, by calculating the carb amounts in each meal, the insulin doses required to preserve postprandial blood glucose within normal limits can be predicted.
In this study we examined the effect of nutrition intervention program using carbohydrate counting on glycemic control and blood lipid profile among type 1 diabetic children and adolescents.
The study was conducted on 80 diabetic patients attending the Diabetes outpatient clinic at Alexandria University Children Hospital (AUCH). The patients were considered eligible if they were aged 6-18 years and the duration of diabetes was at least 5 years. 80 cases were recruited in the study of which 40 cases were considered as the intervention group and were assigned to learning carbohydrate counting and 40 patients took the traditional care only and were considered as the control group. We recruited 40 cases and 40 controls in the study.In this study base line assessment of cases and control as regard body weight, height and body mass index for age percentile was done. In addition, to comparing glycemic indicators (HbA1c and fasting blood glucose level), lipid profile (HDL-C, LDL-C, total cholesterol, triglycerides) and highly sensitive c- reactive protein. Food habit and dietary intake assessment was done to the intervention and control groups.
Also, the energy requirements were determined depending on the age, weight, height and physical activity level according to USDA 2015. In case of obese patients the energy requirements was reduced while patients with normal body weight their requirements was given. Whereas, in patients who are underweight their requirements was increased. Moreover, carbohydrate counting was done to intervention group while the traditional care was given to the control group. Carbohydrate counting allows adjustment of prandial insulin dose for actual carbohydrate intake in type 1 diabetes mellitus on intensive insulin therapy. It allows consumption of a greater variety of foods for patients with type 1 diabetes.
The energy intake and food components were determined according to the guidelines of ADA.CHO intake was 50-60 % of the total daily energy intake. Carbohydrate food groups include: starch (cereals, starchy vegetables and legumes), fruits and milk. Low glycemic index carbohydrate food choices were recommended.Examples of carbohydrate-containing foods with a low GI are dried beans and legumes (like kidney beans and lentils), all non-starchy vegetables, some starchy vegetables like sweet potatoes, most fruit, and many whole grain breads and cereals (like barley, whole wheat bread, rye bread, and all-bran cereal). In addition, protein intake was 15-20 % of the total daily energy intake. Moreover, fat intake was 25-35%of the total daily energy intake (appendix 3). The intervention focused on reducing saturated fat, which is found in full fat dairy products, fatty meats and high fat snacks, and cholesterol which is found in eggs, liver, fast food butter, shell fish, red meat, cheese, shrimps, sausages and pastries and increasing mono unsaturated fatty acids found in olive, sesame, nuts and peanut butter and poly unsaturated fatty acids which are derived from corn, sunflower, soy bean and oily marine fish.
The intervention was followed every 2 weeks to assess their weight status and adherence torecommend dietary modification. In addition, fasting blood sugar level was assessed every 2 weeks.
Laboratory investigation (HbA1c,fasting blood sugar level, lipid profile and hsCRP) was done for both the intervention and the control group to evaluate the impact of the program and carbohydrate counting. Same assessment was done after 3 months to evaluate the impact of the program.
The present study showed that underweight cases (BMI <5th percentile) gained weight significantly by 10.2 %. Moreover, the results show that the mean fasting blood glucose level decreased significantly by 6.3% in cases. As regards the glycosylated haemoglobin, the mean level of glycosylated haemoglobin decreased significantly by 8.4% in cases. The study showed that HbA1c was reduced significantly after the study intervention, although they did not achieve the established values for good glycemic control. Furthermore, the results showed that the mean total cholesterol level decreased significantly by 5.3% in cases. As regards the mean LDL-C level, the mean LDL-C decreased significantly by 5.3% in cases. The mean HDL-C decreased insignificantly in cases by 7.3%. Furthermore, the mean Triglycerides level decreased significantly by 0.8% in cases. Finally, the mean highly sensitive CRP decreased insignificantly by 2.4% in cases.
In conclusion, our study shows that applyingmedical nutrition therapy including carbohydrate counting to patients with type 1 diabetes treated with multiple dose injection of insulin obtains a modest, although significant, decrease in glycosylated haemoglobin not accompanied by an increase in hypoglycemic events. Moreover, the intervention through carbohydrate counting method improved the metabolic control including lipid profile in diabetic patients. Furthermore, carbohydrate counting was associated with increase in BMI in underweight diabetic patients.
It is recommended to implement a national program for educating type 1 diabetic children about CHO counting for example to be part of the school insurance system. The government should in force a law that all food industries should label all snack food regarding CHO content and fat content.