DM: Carbohydrate Management Strategies (2014)

Intervention
In adults with type 1 and type 2 diabetes, what carbohydrate management strategies (such as carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists/food lists/carbohydrate choices) are effective, in terms of glycemia (A1C or glucose)?
- Conclusion
  Eight studies based on carbohydrate-counting, using insulin-to-carbohydrate ratios for three to six months. reported significant decreases in A1C of -1.6% to -0.4% in adults with type 1 and type 2 diabetes on multiple daily injections of insulin (MDI) or insulin pump therapy, as well as continued maintenance of the significant improvement for up to 44 months. Four studies reported mixed effects on glucose levels when using this carbohydrate management strategy.
  No studies evaluating effectiveness of carbohydrate-counting alone, carbohydrate consistency, plate method or exchange lists/food lists/carbohydrate choices as carbohydrate management strategies on glycemia were identified. Long-term studies are needed investigating these approaches.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In adults with type 1 and type 2 diabetes, what carbohydrate management strategies [such as (1) carbohydrate counting alone; (2) carbohydrate counting using insulin-to-carbohydrate ratios; (3) carbohydrate consistency; (4) plate method; and (5) exchange lists, food lists and carbohydrate choices] are effective in terms of glycemia (A1C and glucose)?
- Search Plan and Results: DM: Carbohydrate Management Strategies 2013
In adults with type 1 and type 2 diabetes, what carbohydrate management strategies (such as carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists/food lists/carbohydrate choices) are effective, in terms of quality of life?
- Conclusion
  Four studies based on carbohydrate counting using insulin-to-carbohydrate ratios reported significant improvements in quality of life at six and 12 months, which were maintained at 30 and 44 months, in adults with type 1 diabetes on multiple daily injections of insulin (MDI) or insulin pump therapy.
  No studies evaluating effectiveness of carbohydrate counting alone, carbohydrate consistency, plate method or exchange lists/food lists/carbohydrate choices as carbohydrate management strategies on quality of life were identified. No research was identified on carbohydrate management strategies and quality of life in subjects with type 2 diabetes. Long-term studies are needed investigating these approaches.
- Grade: I
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In adults with type 1 and type 2 diabetes, what carbohydrate management strategies [such as (1) carbohydrate counting alone; (2) carbohydrate counting using insulin-to-carbohydrate ratios; (3) carbohydrate consistency; (4) plate method; and (5) exchange lists, food lists and carbohydrate choices] are effective in terms of quality of life?
- Search Plan and Results: DM: Carbohydrate Management Strategies 2013
In adults with type 1 and type 2 diabetes, what carbohydrate management strategies (such as carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists/food lists/carbohydrate choices) are effective, in terms of weight management (pounds, waist circumference or BMI)?
- Conclusion
  Three studies based on carbohydrate counting using insulin-to-carbohydrate ratios reported either no significant changes or a decrease in weight, waist circumference and BMI in adults with type 1 and type 2 diabetes on multiple daily injections of insulin (MDI) or insulin pump therapy. However, one study reported a modest increase in weight of approximately 2.3% over six months in subjects with type 2 diabetes and one study reported a modest increase of approximately 1.5kg over 44 months in subjects with type 1 diabetes.
  No studies evaluating effectiveness of carbohydrate counting alone, carbohydrate consistency, plate method or exchange lists/food lists/carbohydrate choices as carbohydrate management strategies on weight management were identified. Long-term studies are needed investigating these approaches.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In adults with type 1 and type 2 diabetes, what carbohydrate management strategies [such as (1) carbohydrate counting alone, (2) carbohydrate counting using insulin-to-carbohydrate ratios, (3) carbohydrate consistency, (4) plate method, (5) exchange lists, food lists and carbohydrate choices] are effective in terms of weight management (pounds, waist circumference and BMI)?
- Search Plan and Results: DM: Carbohydrate Management Strategies 2013
In adults with type 1 and type 2 diabetes, what carbohydrate management strategies (such as; carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists/food lists/carbohydrate choices) are effective, in terms of CVD risk factors (lipids or blood pressure)?
- Conclusion
  The majority of studies based on carbohydrate counting using insulin-to-carbohydrate ratios reported no significant impact of this carbohydrate management strategy on total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and blood pressure in adults with type 1 and type 2 diabetes on multiple daily injections of insulin (MDI) or insulin pump therapy.
  
  No studies evaluating effectiveness of carbohydrate counting alone, carbohydrate consistency, plate method, or exchange lists/food lists/carbohydrate choices as carbohydrate management strategies on CVD risk factors were identified. Subjects did not have or were not described as having any disorders of lipid metabolism or hypertension. Long-term studies are needed investigating these approaches, especially in adults with diabetes who have disorders of lipid metabolism and hypertension.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In adults with type 1 and type 2 diabetes, what carbohydrate management strategies [such as (1) carbohydrate counting alone; (2) carbohydrate counting using insulin-to-carbohydrate ratios; (3) carbohydrate consistency; (4) plate method; and (5) exchange lists, food lists and carbohydrate choices] are effective in terms of CVD risk factors (lipids and blood pressure)?
- Search Plan and Results: DM: Carbohydrate Management Strategies 2013
In adults with type 1 and type 2 diabetes, what impact do carbohydrate management strategies (such as carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists, food lists, carbohydrate choices) have on medication usage (insulin or other glucose-lowering medications)?
- Conclusion
  Three studies, based on carbohydrate-counting using insulin-to-carbohydrate ratios, reported that insulin doses increased, as needed, by one to two doses per day or the insulin amount varied depending on the planned carbohydrate intake in adults with type 1 and type 2 diabetes on multiple daily injections of insulin (MDI) or insulin pump therapy. In addition, three other studies reported that no changes were needed in the amount of the total daily dose of insulin.
  No studies evaluating effectiveness of carbohydrate counting alone, carbohydrate consistency, plate method or exchange lists, food lists or carbohydrate choices as carbohydrate management strategies on medication usage were identified. No studies were identified that reported on the impact of implementing carbohydrate management strategies on glucose-lowering medications. Long-term studies are needed investigating these approaches.
- Grade: II
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In adults with type 1 and type 2 diabetes, what impact do carbohydrate management strategies (such as carbohydrate counting alone; carbohydrate counting using insulin-to-carbohydrate ratios; carbohydrate consistency; plate method; exchange lists/food lists/carbohydrate choices) have on medication usage (insulin or other glucose-lowering medications)?
- Search Plan and Results: DM: Carbohydrate Management Strategies 2013