Endocrine Abstracts

Introduction: A systematic review and meta-analysis undertaken by Bell et al, 2013 found limited evidence to recommend carbohydrate counting as the standard dietary therapy in Type 1 Diabetes (T1DM). There seems to be a gap in current knowledge about comparing carbohydrate counting with other meal planning approaches for children and young people (CYP) with diabetes and the effects on clinical outcomes (Gillespie et al. 1998). Current literature also suggests that there are limitations in the approaches to insulin dosing primarily based on carbohydrate counting (Bell et al. 2015).

Aim: To explore the barriers and facilitators to carbohydrate counting from the perspective of nurses and dietitians working with CYP with T1DM.

Method: A qualitative study based on 8 semi-structured interviews with nurses and dietitians. The three dimensions (Process, Content and Context) of Pettigrew and Whipp’s theoretical framework were used to undertake structured data analysis.

Results: Participants perceived mathematic calculation and the school environment as barriers to carbohydrate counting. Nurses and dietitians found the concept of fat and protein counting to be complex but felt that it may facilitate diabetes management if educational resources and technology were developed to support it.

Conclusion: The outcome of the study suggests that carbohydrate counting has been embedded in clinical practice in the acute setting for patients diagnosed after the introduction of the Best Practice Tariff, but new models of working need to be looked at for teenage patients and in the school environment. Future research into the role of fat and protein counting in the provision of a stronger evidence base for clinical decision making also needs to be considered.