Development and Evaluation of a Structured Carbohydrate Counting Group-based Education Programme in Adults with Type 1 Diabetes: a pilot study

Abstract

Background: Structured education programmes (SEPs) for individuals with Type 1 diabetes mellitus (T1DM) are a well-established approach for delivering the knowledge and skills necessary for self-management of their diabetes. As carbohydrates are a major determinant of post-prandial blood glucose, carbohydrate counting and insulin dose adjustment have been shown to improve both biochemical and psychological patient outcomes. However, there is little evidence to support an ‘ideal’ method for delivering SEPs. Objective: The main aim of this study was to develop, pilot and evaluate a structured carbohydrate counting group-based education programme to establish the regular delivery of a carbohydrate counting SEP at the Hawke’s Bay Specialist Diabetes Service (HBSDS). Methods: The study was conducted in three phases. Firstly, an online questionnaire was emailed to Dietitians nationwide to investigate currently available structured carbohydrate counting group-based education programmes in New Zealand (NZ). The second phase involved designing and piloting a carbohydrate counting SEP (the study programme). The study programme was designed using: a national consensus set out by Diabetes Australia, current carbohydrate counting SEPs run in NZ and well evaluated programmes from the literature. For the pilot, six participants were randomly selected. The study programme involved 12 hours of education time separated into two sessions, one week apart. The programme covered all aspects of carbohydrate counting and insulin dose adjustment. The third phase involved measuring participant outcomes at baseline and follow up. This included an assessment of pre- and postprandial glucose excursions measured by the percentage of glucose measurements within a target range and number of hypoglycaemic episodes. Also, carbohydrate counting knowledge, fear of hypoglycaemia, quality of life (QoL), and treatment satisfaction were measured. Evaluation of the programme was measured using the structured diabetes education improvement toolkit. Results: Over half (55%) of Dietitians who responded to the initial questionnaire offered a carbohydrate counting SEP. Most commonly, SEP sessions were held weekly (36.4%), with four or more sessions (54.5%) lasting for longer than 180 minutes (54.5%). Only 63.6% of these SEPs had been evaluated. In the study programme, mean age of the participants was 50 ± 2.7 years with 50% female. Mean length of time diagnosed was 22.2 ± 17.8 years. Participants showed a significant increase in overall carbohydrate counting knowledge (p=0.026). No significant differences were seen in fear of hypoglycaemia, QoL or treatment satisfaction. No change was seen in the percentage of blood glucose readings within the target range of ≥4mmol/L - ≤10mmol/L or number of hypoglycaemic episodes. Feedback from participants and facilitators was assessed using qualitative methods. Generally, positive feedback was received. Conclusion: There is a large variety in the type of carbohydrate counting SEPs offered in NZ. The pilot study was effective in improving participants’ carbohydrate counting knowledge and positive feedback was received with only minor improvements to be made to the initial programme. Overall, this study programme and resource book reflects a carbohydrate counting SEP which could be delivered regularly at the HBSDS.