IMPACT OF ADVANCED CARBOHYDRATE COUNTING INTENSIVE PROGRAM IN TYPE 1 DIABETES THROUGH WHATSAPP-BASED MONITORING

Abstract

INTRODUCTION/BACKGROUND
Advanced carbohydrate counting is a meal planning method that allows better flexibility and glycaemic control. However, adopting and maintaining this nutritional therapy for long-term effectiveness can be highly challenging for individuals with type 1 diabetes (T1D).

METHODOLOGY
Using technology to facilitate patient access and offer real-time feedback, we aimed to assess the effectiveness of a multidisciplinary collaboration educational program known as the Advanced Carbohydrate Counting Intensive Program (ACCIP). This retrospective observational study involves T1D patients enrolled in ACCIP via a WhatsAppbased group monitoring from July 2020 to December 2022 in Hospital Queen Elizabeth II. The study included patients who could send food diary photographs and perform carbohydrate counting via WhatsApp Group for at least two meals a day for seven days. HbA1c measurements were recorded at initiation, 3-to-6 months and 9-to-12 months after the program ended.

RESULT
The analysis included 62 patients with T1D who met the inclusion criteria. There were 22 (35.5%) men and 40 (64.5%) women. The median age of patients was 31.0 ± 10.2 years, with a median diabetes duration of 8.5 years ± 7.8 years and a median initial HbA1c of 9.2% ± 2.9. A total of 40 (64.5%) patients were able to maintain advanced carbohydrate counting (ACC) 12 months after the program ended. Overall, median HbA1c decreased significantly 3-to 6 months following the ACC intensive program (-1.1%, P <0.01). Reductions were maintained at 9-to-12 months but were not significant (-0.6%, P = 0.086). Subgroup analysis showed significant HbA1c reduction in patients who maintain ACC at 3 to 6 months (-1.5%, P = 0.01) and 9 to 12 months (-1.4%, P = 0.02).

CONCLUSION
Early and real-time intensive education in advanced carbohydrate counting via digital platforms may provide a long-term positive impact on glucose control. Larger clinical trials with structured programs are warranted to validate this positive impact.