Death to Carbohydrate Counting?
- Nichola J. Davis, MD, MS1 and
- Judith Wylie-Rosett, EDD, RD2
- 1Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
- 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Corresponding author: Judith Wylie-Rosett, jwrosett{at}aecom.yu.edu
Insulin therapy is an effective strategy for achieving glycemic control in patients with type 2 diabetes. Although often neglected, it is important to use an appropriate diet strategy to complement the insulin. Furthermore, a basic tenet of such therapy is that insulin dosage and administration should be appropriate to balance diet and physical activity in order to maintain normoglycemia.
In this issue of Diabetes Care, Bergenstal et al. (1) evaluated two strategies for determining the appropriate dosage of mealtime bolus insulin. A simple algorithm that adjusted bolus insulin dose based on weekly average of premeal glucose was compared with an algorithm based on mealtime carbohydrate counting. The authors demonstrated the equivalence of both the simple strategy and the more elaborate carbohydrate-counting strategy in achieving glycemic control; almost one-half the participants in both groups achieved an A1C <6.5%. Can patients with type 2 diabetes treated with basal:bolus insulin succeed without adding the complexity of carbohydrate counting?
Carbohydrate counting has been around since the 1920s and became integral in managing patients with type 1 diabetes after the landmark findings of the Diabetes Control and Complications …
