{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:03:22Z","timestamp":1791932602728,"version":"4.3.4"},"reference-count":44,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>\n                      Diabetes mellitus (DM) is one of the most prevalent chronic noncommunicable diseases globally, and the only way to reduce its complications is good glycaemic control. Insulin remains the only approved treatment for type 1 DM (T1DM) and is used by many with type 2 DM (T2DM). Carbohydrate counting is considered the ideal way to calculate meal\u2010related insulin doses as it allows greater flexibility in diet and could, in some people, reduce the burden of the disease. The primary objective of this systematic review was to assess carbohydrate counting efficacy in reducing glycated haemoglobin (HbA\n                      <jats:sub>1c<\/jats:sub>\n                      ) levels and safety by not increasing hypoglycaemia risk, inducing an increase in body weight or blood lipids, or reducing the quality of life of people with T1DM.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We included randomised controlled clinical trials with a parallel\u2010group design comparing any carbohydrate counting forms with standard care or other forms of dietary advice or insulin dose calculation in people with T1DM with a follow up period of at least 3 months and with no restrictions in language, age or settings. As a primary outcome, we consider the change of HbA\n                      <jats:sub>1c<\/jats:sub>\n                      levels within at least 3 months. Secondary outcomes were hypoglycaemia events, body weight changes, blood lipids levels, and the total daily insulin dose. We also evaluated health\u2010related quality\u2010of\u2010life changes and questionnaires on satisfaction with treatment of diabetes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 11 studies with 899 patients were retrieved with a mean follow\u2010up of 52 \u00b1 35.5 weeks. Carbohydrate counting is not better in reducing HbA\n                      <jats:sub>1c<\/jats:sub>\n                      levels (SMD\u20100.24%, 95% CI \u22120.68 to 0.21) than all dietary advice forms. However, this finding was highly heterogeneous. We identified three studies that account for most of the heterogeneity using clustering algorithms. A second analysis excluding these studies shows a meaningful reduction in HbA\n                      <jats:sub>1c<\/jats:sub>\n                      levels (SMD\u20100.52%, 95% CI \u22120.82 to \u22120.23) with low heterogeneity. In the subgroup analysis, carbohydrate counting significantly reduces HbA\n                      <jats:sub>1c<\/jats:sub>\n                      levels compared with usual diabetes education. Carbohydrate counting does not relate to any substantial change in blood lipids, body weight, hypoglycaemia risk or daily insulin dose. Finally, we analysed the effect of trial duration on reduction in HbA\n                      <jats:sub>1c<\/jats:sub>\n                      levels and found no significant change related to time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Carbohydrate counting is an efficacious technique to safely reduce the levels of HbA\n                      <jats:sub>1c<\/jats:sub>\n                      in adults and children compared with standard diabetes education, and its effect does not appear to change with prolonged time. Standardisation in reporting important outcomes such as hypoglycaemia and quality of life are vital to produce comparable evidence in carbohydrate counting clinical trials. This systematic review was registered in PROSPERO under code: CRD42020218499.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jhn.13017","type":"journal-article","created":{"date-parts":[[2022,4,18]],"date-time":"2022-04-18T12:23:43Z","timestamp":1650284623000},"page":"1030-1042","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Efficacy and safety of carbohydrate counting versus other forms of dietary advice in patients with type 1 diabetes mellitus: a systematic review and meta\u2010analysis of randomised clinical trials"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2418-6159","authenticated-orcid":false,"given":"Carlos E.","family":"Builes\u2010Monta\u00f1o","sequence":"first","affiliation":[{"name":"Endocrinology Section, Internal Medicine Department, School of Medicine Universidad de Antioquia  Medell\u00edn Colombia"},{"name":"Diabetes Education Group, Hospital Pablo Tob\u00f3n Uribe  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia A.","family":"Ortiz\u2010Cano","sequence":"additional","affiliation":[{"name":"Pharmacy Department Hospital Pablo Tob\u00f3n  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Ramirez\u2010Rinc\u00f3n","sequence":"additional","affiliation":[{"name":"Cl\u00ednica Integral de Diabetes (CLID)  Medell\u00edn Colombia"},{"name":"Endocrinology Section, School of Medicine Universidad Pontificia Bolivariana  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia A.","family":"Rojas\u2010Henao","sequence":"additional","affiliation":[{"name":"Diabetes Education Group, Hospital Pablo Tob\u00f3n Uribe  Medell\u00edn Colombia"},{"name":"School of Pharmaceutical and Food Science Universidad de Antioquia  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2010.01.026"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1020-49892009000700009"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.18.2.258"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.20.7.1162"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7134.823"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.1.63"},{"key":"e_1_2_11_9_1","unstructured":"GosmanovAR GosmanovaEO KitabchiAE FeingoldKR AnawaltB BoyceA et al. 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