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Recommendations Summary

DM: Carbohydrate 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    DM: Carbohydrate Intake Consistency

    In persons receiving either MNT alone, glucose-lowering medications or fixed insulin doses,  meal and snack carbohydrate intake should be kept consistent on a day-to-day basis. Consistency in carbohydrate intake results in improved glycemic control.

    Rating: Strong
    Conditional

    DM: Carbohydrate Intake and Insulin Dose Adjustment

    In persons with type 1 or type 2 diabetes who adjust their mealtime insulin doses or who are on insulin pump therapy,  insulin doses should be adjusted to match carbohydrate intake (insulin-to-carbohydrate ratio). This can be accomplished by comprehensive nutrition education and counseling on interpretation of blood glucose patterns,  nutrition-related medication management and collaboration with the healthcare team.  Adjusting insulin dose based on planned carbohydrate intake improves glycemic control and quality of life without any adverse effects.

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      • Although total carbohydrate content of meals and snacks is the first priority, macronutrient content and total energy intake cannot be ignored as excessive energy intake may lead to weight gain, even if glycemic control is maintained.
      • Diets too low in carbohydrate eliminate many foods that are important sources of vitamins, minerals, fiber and energy.

    • Conditions of Application

      • The scope of practice of the RD and standards of professional performance defines the role of the RD in medication adjustment.

    • Potential Costs Associated with Application

      • Although costs of MNT sessions and reimbursement vary, medical nutrition therapy sessions are essential for improved outcomes.

    • Recommendation Narrative

      • Two studies in subjects with Type I diabetes based the adjustment of mealtime insulin to match planned carbohydrate intake (DCCT, 1993; DAFNE Study Group, 2002) and three studies based on day-to-day consistency in carbohydrate intake resulted in improved glycemic control (Wolever et al, 1999; Boden et al, 2005; Nielsen, Jonsson, and Nilsson, 2005). 
      • Of four studies evaluating differing percentages of carbohydrate, the evidence was inconclusive (Garg et al, 1994; Komiyama et al, 2002; Gerhard et al, 2004; Nielsen, Jonsson, and Ivarsson, 2005).

       

    • Recommendation Strength Rationale

      •  Conclusion Statement was given Grade I       

    • Minority Opinions

      Consensus reached.