Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis.

Autor:	Vaz EC; Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (Unesp), Botucatu, SP, Brasil., Porfírio GJM; Centro Cochrane do Brasil, Disciplina de Medicina de Urgência e Medicina Baseada em Evidências, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil., Nunes HRC; Departamento de Saúde Pública, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (Unesp), Botucatu, SP, Brasil., Nunes-Nogueira VDS; Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (Unesp), Botucatu, SP, Brasil.
Jazyk:	angličtina
Zdroj:	Archives of endocrinology and metabolism [Arch Endocrinol Metab] 2018 Jun; Vol. 62 (3), pp. 337-345. Date of Electronic Publication: 2018 May 17.
DOI:	10.20945/2359-3997000000045
Abstrakt:	Objective: This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). Materials and Methods: We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: -0.49 (-0.85, -0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. Conclusion: The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.
Databáze:	MEDLINE
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