Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis
Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis
复制标题
DOI：
10.1016/s2213-8587(13)70144-x
复制
发表时间：
2014-02-01
影响因子：
44.5
通讯作者：
Brand-Miller, Jennie C.
中科院分区：
文献类型：
--
作者：
Bell, Kirstine J.;Barclay, Alan W.;Brand-Miller, Jennie C.
背景：虽然碳水化合物计数是1型糖尿病患者实现血糖控制的推荐饮食策略，但该建议是基于对现有证据的叙述性回顾和分级。我们的目的是通过系统评价和荟萃分析来评估碳水化合物计数对成人和儿童1型糖尿病患者血糖控制的功效。方法：我们筛选和评估干预时间超过3个月的随机对照试验，这些试验比较了1型糖尿病成人和儿童的碳水化合物计数与一般或替代饮食建议。糖化血红蛋白（HbA(1c)）浓度的变化是主要结局。使用随机效应模型对临床和统计均质的研究结果进行汇总和荟萃分析，以估计碳水化合物计数的功效。我们从311项可能相关的研究中筛选出7项符合条件的试验，包括599名成人和104名1型糖尿病儿童。学习质量平均得分7.6分（满分13分）。总体而言，与对照组或常规护理相比，碳水化合物计数的HbA（1c）浓度无显著改善（-0.35% [-3.9 mmol/mol], 95% CI -0.75至0.06;p=0.096）。我们发现研究之间存在显著的异质性，这可能与研究设计的差异有关。在平行设计的五项成人研究中，与对照组相比，碳水化合物计数的HbA（1c）降低了0.64% (7.0 mmol/mol) (95% CI -0.91至-0.37
Background Although carbohydrate counting is the recommended dietary strategy for achieving glycaemic control in people with type 1 diabetes, the advice is based on narrative review and grading of the available evidence. We aimed to assess by systematic review and meta-analysis the efficacy of carbohydrate counting on glycaemic control in adults and children with type 1 diabetes.Methods We screened and assessed randomised controlled trials of interventions longer than 3 months that compared carbohydrate counting with general or alternate dietary advice in adults and children with type 1 diabetes. Change in glycated haemoglobin (HbA(1c)) concentration was the primary outcome. The results of clinically and statistically homogenous studies were pooled and meta-analysed using the random-effects model to provide estimates of the efficacy of carbohydrate counting.Findings We identified seven eligible trials, of 311 potentially relevant studies, comprising 599 adults and 104 children with type 1 diabetes. Study quality score averaged 7.6 out of 13. Overall there was no significant improvement in HbA(1c) concentration with carbohydrate counting versus the control or usual care (-0.35% [-3.9 mmol/mol], 95% CI -0.75 to 0.06; p=0.096). We identified significant heterogeneity between studies, which was potentially related to differences in study design. In the five studies in adults with a parallel design, there was a 0 64% point (7.0 mmol/mol) reduction in HbA(1c) with carbohydrate counting versus control (95% CI -0.91 to -0.37; p