ADA2013：碳水化合物计数法在1型糖尿病中的作用有待更多研究
The Efficacy of Carbohydrate Counting in Type 1 Diabetes: A Systematic Review and Meta-Analysis
Although carbohydrate counting is the recommended dietary strategy for achieving glycemic control in people with type 1 diabetes the advice is based on narrative review and grading of the available evidence. Our objective was to conduct a systematic review and meta-analysis of the efficacy of carbohydrate counting on glycemic control in adults and children with type 1 diabetes.
We screened and assessed randomized controlled trials (RCTs) of interventions >3 months duration that compared carbohydrate counting with general or alternate dietary advice in adults and children with type 1 diabetes. Change in glycated hemoglobin (HbA1c) was the primary outcome. Hypoglycemia insulin dose weight change and quality of life were secondary outcome measures.
Of 294 potentially relevant studies we identified 6 eligible RCTs comprising 563 adults and 104 children with type 1 diabetes. Study quality score averaged 7.7 out of 13. Overall there was a non-significant decrease in HbA1c (-0.3% points) with carbohydrate counting versus the control or alternate advice (p = 0.185). In adults only there was a -0.4% point improvement which was marginally significant (p = 0.048). Five studies reported a non-significant decrease in the frequency of hypoglycemia in the carbohydrate counting group.
There is limited evidence to recommend carbohydrate counting as the standard dietary therapy in type 1 diabetes. Additional studies are required to support this strategy in routine clinical care.
虽然碳水化合物计数法是1型糖尿病人实现血糖控制的推荐膳食，这是基于现有证据的回顾和等级分析提出的。我们目的是开展系统性的回顾和meta分析，评估患有1型糖尿病的成年人和儿童中碳水化合物计数法对血糖控制的疗效。结果发现碳水化合物计数法不能显著改善病人的主要指标。
本研究筛选和评估了干预持续时间大于3个月的随机对照试验，该项试验对比分析了1型糖尿病的成年人和儿童人群中碳水化合物计数法和一般（或备用）饮食方法的疗效。主要评价指标为糖化血红蛋白（HbA1c）的变化情况。低血糖胰岛素剂量体重变化和生活质量是次要检测指标。在294次潜在相关研究中，我们最终确定了6次合格的随机对照试验，包括563位成年和104位儿童1型糖尿病患者。研究质量平均得分7.7。总体上，碳水化合物计数组与对照组或备用饮食法组相比，糖化血红蛋白没有显著下降（-0.3%点）（P=0.185）。仅成年人糖尿病组有显著的改善（-0.4%点）（P=0.048）。在低血糖频率方面，5次试验结果表明碳水化合物计数组没有显著降低。
将碳水化合物计数法作为1型糖尿病患者的标准治疗方法，证据比较局限。在常规的临床护理当中，需要更多地研究资料支持这一治疗方法。
ADA是美国糖尿病学会 (Americn Diabetos Association)的缩写，美国糖尿病协会县美国重要的非赢利性卫生姐织，旨在提供有关糖尿病的研究进展和信息，促进糖尿病的科研、教育、诊疗等，关注一切与糖尿病有关的事务。