Carbohydrate Counting in Children and Adolescents With Type 1 Diabetes
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      The total amount of carbohydrates (CHO) at meal consumed strongly predicts the glycemic
      response in children and adolescents with type 1 diabetes. Carbohydrate counting is a
      technique to adapt a dose of rapid acting insulin to the carbohydrate content of a meal.
      Thanks to this flexible insuline therapy, the glycemic control and the quality of life tend
      to improve. Carbohydrate counting is a recommended technique in the adult diabetic
      population. There is little data on the use of this methode in youth with diabetes. There are
      no studies on the change of carbohydrates content at meals in children and adolescents with
      diabetes practicing counting carbs, while it is the main interest of this technique. The aim
      of this study is to assess how children and adolescents with type 1 diabetes use the
      possibility to change their carbohydrate amount at each main meal when they use the counting
      carb method. The investigators hypothesize that children vary their amount of CHO greatly.
      This is an argument for using this technique in pediatrics
    

Detailed description: 
      The chalenge of the treatment of children and adolescents with type 1 diabetes is to maintain
      a normoglycemia to prevent the complications of diabetes. The post prandial glycemic control
      is directly inflenced by the CHO content of the meal and the carbohydrates must represent
      about 55% of the daily needs. There is a linear relation between carbohydrate intake and
      insuline need. CHO counting is a technique to match a bolus insuline dose to the total
      carbohydrate content of the meal. An insulin to carbohydrate ratio is used. The method
      contrasts with fixed insulin regimen. There is a lack of studies on CHO counting particulary
      in pediatric population. However, there are currently international recommendations
      supporting the use of CHO counting in the management of type 1 diabetes because it improves
      the quality of life, tends to improve the HbA1c and limits hypoglycemia without increasing
      the BMI. There is no pediatric study on the variation of the amount of CHO at each of the
      main 4 daily meals.

      Aims The investigators hypothesize that children vary greatly their total meal CHO .This is
      an argument for this technique.

      Primary aim :

      To assess how children and adolescents (aged 1 to 18) use this possibility to change the
      amount of CHO at breakfast, at lunch, at snack, at dinner and from day to day.

      Secondary aims :

        -  To identify a correlation between the variation of CHO and environnemental factors such
           as school or disease and medical factors such as glycemic control and BMI.

        -  To compare the total CHO intake of our pediatric population with international
           recommendations Methods A logbook is given to the patient to detail the amount of
           carbohydrates in the meal and place and event during these meal.

      This self monitoring logbook must be completed over 28 days between two consultations.

      The investigators will include 80 patients during 18 months
    

Intervention name(s): carbohydrate counting
Intervention type(s): Other
Intervention description(s): patients must fill their logbook with the following data:
cho amount at breakfast, lunch, snack and dinner
insulin amount at breakfast, lunch, snack and dinner
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: diabetes; children