DM is a complication of cystic fibrosis and it’s caused mainly by insulin deficiency. A glycometabolic decompensation, due to incorrect therapeutic management, leads to a worsening of the catabolic state (already caused by malabsorption and high metabolic requests, and a known risk factor for worsening of respiratory function). The therapy for CFRD is insulin. Cho-counting, an effective technique to manage insulin therapy in T1DM subjects, allows patients to achieve a better glycemic control.
Aim: to evaluate the efficacy of cho-counting in patients with CFRD on glycemic control.
Materials and Methods: 21 patients with CFRD, randomized in 2 groups. gr.1: 9 patients performing cho-counting; gr.2: 12 patients followed according to ambulatory standard care. Glycometabolic control was evaluated with: a. variation of HbA1c, b. variation of pre and postprandial average SMBG in a period of 12 months. In group 1, the I/CHO ratio obtained with the 500-formula was compared with those obtained from food and glucose diaries.
Results: gr.1 showed a reduction of HbA1c, compared to gr. 2 (7.4 ± 0.9% to 6.6 ± 0.3%, Δ -0.8% vs. 7.4 ± 1.5% to 7.5 ± 1.4%, Δ + 0.1%, P <0.05). There was also an improvement, even if not significant, in gr.1 and a worsening (p <0.05 for post) in gr.2, of pre and post-prandial average SMBG. In gr.1, the I/CHO ratio obtained through the 500-formula was 1/20. Based on diaries, it was 1/18 for breakfast, 1/25 for lunch and 1/25 for dinner.
Conclusions: Cho-counting is effective in improving glycometabolic control in individuals with CFRD, avoiding the risk to worsen the already delicate metabolic balance of these patients. The use of dietary and glycemic diaries allows to estimate the I/CHO ratio differentiating the insulin needs during the day. This allows a more accurate personalization of the therapy compared to the use of 500-formula, which, in these patients, often overestimate the need for insulin at meals.
V. Grancini: Board Member; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. A. Gaglio: Consultant; Self; Roche Diabetes Care. V. Resi: Speaker's Bureau; Self; Sanofi. E. Palmieri: Speaker's Bureau; Self; Eli Lilly and Company. E. Orsi: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis.
