Miglioramento delle strategie di coping, qualità della vita e controllo metabolico in persone con diabete di tipo 1 seguite mediante Group care e conta dei carboidrati

Carbohydrate counting improves coping ability and metabolic control in patients with type 1 diabetes managed by Group Care This study aimed at assessing the effects of adding a carbohydrate counting programme to continuing education by Group Care on coping ability, quality of life, knowledge of diabetes and metabolic control in patients with type 1 diabetes. Out of 56 patients followed by Group Care, 27 were randomized to receive an 8-session carbohydrate counting programme and 29 controls continued Group Care without such formal training. Quality of life, knowledge and coping ability were assessed at baseline and after 30 months. HbA1c, body weight, blood glucose, hypoglycaemic episodes and insulin dosages were checked every 3 months. Quality of life improved (p < 0.001) both in patients receiving the carbohydrate counting programme (88.7 ± 9.2 vs 78.0 ± 9.9) and controls (88.7 ± 12.5 vs 80.4 ± 11.7). Knowledge (9.3 ± 1.7 vs 10.6 ± 0.6, p < 0.001) and the 3 coping areas (problem solving: 28.1 ± 1.9 vs 30.0 ± 1.6, p < 0.001; social support seeking: 18.0 ± 4.4 vs 16.9 ± 5.1,p < 0.05; avoidance: 16.7 ± 3.6 vs 14.8 ± 3.5, p < 0.005) improved significantly more in the patients receiving the carbohydrate counting programme. All these showed a greater though not significant improvement in patients with poor schooling. At 30 months, HbA1c was lower after the carbohydrate counting programme than in the controls (7.2 ± 0.9 vs 7.9 ± 1.4), p < 0.05. There were no changes in insulin dosage, hypoglycaemic episodes or blood lipids. These results confirm that Group Care improves quality of life in type 1 diabetes but suggest that specific educational and psychological supports are needed to modify adaptation to the disease. The carbohydrate counting programme we developed appears effective in promoting change, also in patients with poor schooling.