Highlights
- •Advanced carbohydrate counting improves HbA1c in adults with type 1 diabetes.
- •Concomitant automated bolus calculator use further improves HbA1c.
- •Numeracy is significantly associated with change in HbA1c.
- •An automated bolus calculator does not compensate for poor numeracy skills.
- •An automated bolus calculator reduces fear of hypoglycemia.
Abstract
Aims
The purpose of this secondary analysis of the StenoABC Study was to identify determinants
of the changes in HbA1c observed after training of people with type 1 diabetes in
advanced carbohydrate counting (ACC) and automated bolus calculator (ABC) use, and
further to investigate psychosocial effects of these insulin dosing approaches.
Methods
Validated diabetes-specific questionnaires were used to assess diabetes treatment
satisfaction, problem areas in diabetes, fear of hypoglycemia and diabetes dependent
quality of life before and one year after the training. In addition, numeracy was
tested (using a non-validated test developed specifically for this study) and behavioral
measures (number of daily blood glucose measurements and self-reported use of ACC)
were obtained. Associations between change in HbA1c and these measures plus sex, age,
diabetes duration and BMI were tested.
Results
Numeracy was the only baseline predictor of yearly change in HbA1c identified. Higher
levels of numeracy were associated with greater reductions in HbA1c (P = 0.031). No associations between change in HbA1c and the behavioral measures investigated
were found, nor were any clinically relevant associations between changes in HbA1c
and questionnaire scores. Treatment satisfaction increased in all users of ACC (P < 0.001). People who also used an ABC reported significantly lower levels of fear of
hypoglycemia than people who practiced ACC without such device (P = 0.005).
Conclusions
Improvements in HbA1c after training in ACC were inversely related to numeracy. Use
of an ABC did not compensate for poor numeracy skills. However, device use reduced
fear of hypoglycemia compared with ACC without ABC use.
Keywords
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Article info
Publication history
Published online: May 19, 2017
Accepted:
May 16,
2017
Received in revised form:
May 8,
2017
Received:
March 27,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
