{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:21Z","timestamp":1787721621960,"version":"build-2784847793"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Carbohydrate counting is central to dietary self-management in patients with type 1 diabetes mellitus (T1DM). However, objective assessments of carbohydrate counting knowledge and its relationship with psychosocial outcomes are scarce in Gulf populations. This study assessed carbohydrate counting knowledge, diabetes distress, and hypoglycaemia awareness in patients with T1DM attending a tertiary diabetes centre in the United Arab Emirates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross-sectional study of 40 patients with T1DM (age \u2265 14 years, diabetes duration \u2265 12 months) attending the Tawam Hospital Diabetes Clinic, Al Ain, UAE. Carbohydrate counting knowledge was assessed using the Arabic version of the 43-item AdultCarbQuiz questionnaire. Diabetes distress was\u00a0measured using the two-item Diabetes Distress Scale (DDS-2), and hypoglycaemia awareness was measured using the Gold score. Pearson\u2019s correlations, one-way analysis of variance (ANOVA) across knowledge quartiles, and partial correlations adjusted for HbA1c and Gold score were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean AdultCarbQuiz score was 26.2 \u00b1 4.0 out of 43 (60.9%). Domain analysis revealed strong carbohydrate food recognition (domain mean 80.1% correct) but poor quantification skills (20-27.5% correct for portion estimation) and meal-level counting (2.5-15% correct). Diabetes distress was present in 37.5% of the participants, and impaired hypoglycaemia awareness was present in 20.0% of the participants. Knowledge of carbohydrate counting showed a moderate inverse correlation with diabetes distress (r = -0.468, 95% CI -0.68 to -0.18, p\u00a0=\u00a00.002), which strengthened further after adjusting for HbA1c and Gold score (partial r = -0.579, 95% CI -0.77 to -0.30, p &amp;lt; 0.001). In exploratory analyses, younger age (r = -0.404, p = 0.010) and shorter diabetes duration (r = -0.344, p\u00a0=\u00a00.030) were associated with higher knowledge scores. No association was observed between the knowledge scores and HbA1c levels (r = 0.179, p = 0.295).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In this cross-sectional sample, carbohydrate counting knowledge was independently and inversely associated with diabetes distress, regardless of glycaemic control. Specific knowledge gaps in carbohydrate quantification and meal-level counting are actionable targets for educational intervention in this population. These findings highlight the value of addressing both nutritional knowledge and emotional well-being in T1DM management; whether improving carbohydrate-counting knowledge reduces distress requires longitudinal and interventional study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1922652","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:49:12Z","timestamp":1787719752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Carbohydrate counting knowledge and its association with diabetes distress in patients with type 1 diabetes: a cross-sectional study from the United Arab Emirates"],"prefix":"10.3389","volume":"17","author":[{"given":"Adnan","family":"Agha","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sozan Yasser","family":"Rakha","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bachar","family":"Afandi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Tawam Hospital","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishan Sudheera","family":"Kalupahana","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juma M.","family":"Alkaabi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University","place":["Al Ain, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S77","DOI":"10.2337\/dc24-S005","article-title":"5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2337\/dci19-0014","article-title":"Nutrition therapy for adults with diabetes or prediabetes: a consensus report","volume":"42","author":"Evert","year":"2019","journal-title":"Diabetes Care"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309303291401","article-title":"The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus","volume":"329","author":"Nathan","year":"1993","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1038\/srep37067","article-title":"Effectiveness of advanced carbohydrate counting in type 1 diabetes mellitus: a systematic review and meta-analysis","volume":"6","author":"Fu","year":"2016","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(13)70144-X","article-title":"Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis","volume":"2","author":"Bell","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8223(93)91750-K","article-title":"Nutrition interventions for intensive therapy in the Diabetes Control and Complications Trial","volume":"93","author":"Snetselaar","year":"1993","journal-title":"J Am Diet Assoc"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2337\/diaspect.24.3.154","article-title":"Validating the AdultCarbQuiz: a test of carbohydrate-counting knowledge for adults with diabetes","volume":"24","author":"Watts","year":"2011","journal-title":"Diabetes Spectr"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2337\/diaclin.34.3.142","article-title":"Accuracy of carbohydrate counting in adults","volume":"34","author":"Meade","year":"2016","journal-title":"Clin Diabetes"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1297\/cpe.24.153","article-title":"The factors affecting on estimation of carbohydrate content of meals in carbohydrate counting","volume":"24","author":"Kawamura","year":"2015","journal-title":"Clin Pediatr Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjnph-2022-000553","article-title":"Evaluation of carbohydrate counting knowledge among individuals with type 1 diabetes mellitus in Saudi Arabia: a cross-sectional study","volume":"5","author":"Bawazeer","year":"2022","journal-title":"BMJ Nutr Prev Health"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-023-02223-8","article-title":"AdultCarbQuiz for the Portuguese population with type 1 diabetes mellitus: translation, cultural adaptation and validation of its metabolic impact","volume":"61","author":"Valentim Lopes","year":"2024","journal-title":"Acta Diabetol"},{"key":"B12","unstructured":"IDF Diabetes Atlas\n          \n          \n          Brussels\n          IDF\n          \n          2021"},{"key":"B13","doi-asserted-by":"publisher","first-page":"98","DOI":"10.34172\/hpp.2020.18","article-title":"Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis","volume":"10","author":"Mobasseri","year":"2020","journal-title":"Health Promot Perspect"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1159\/000497649","article-title":"Carbohydrate food knowledge of Emirati and Omani adults with diabetes: results of a pilot study","volume":"16","author":"Ali","year":"2008","journal-title":"Int J Diabetes Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12818","article-title":"Self-reported diabetes self-management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with type 1 diabetes","volume":"32","author":"Mohn","year":"2015","journal-title":"Diabet. Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2724","article-title":"Reductions in management distress following a randomized distress intervention are associated with improved diabetes behavioral and glycemic outcomes over time","volume":"44","author":"Hessler","year":"2021","journal-title":"Diabetes Care"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12973","article-title":"Prevalence of depression in type 1 diabetes and the problem of over-diagnosis","volume":"33","author":"Fisher","year":"2016","journal-title":"Diabet Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1370\/afm.842","article-title":"Development of a brief diabetes distress screening instrument","volume":"6","author":"Fisher","year":"2008","journal-title":"Ann Fam Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-1572","article-title":"When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale","volume":"35","author":"Fisher","year":"2012","journal-title":"Diabetes Care"},{"key":"B20","doi-asserted-by":"publisher","first-page":"697","DOI":"10.2337\/diacare.17.7.697","article-title":"Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia","volume":"17","author":"Gold","year":"1994","journal-title":"Diabetes Care"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.33808\/clinexphealthsci.630821","article-title":"Assessment of carbohydrate count method knowledge levels and insulin types of individuals with type 1 DM","volume":"9","author":"Arslan","year":"2019","journal-title":"Clin Exp Health Sci"},{"key":"B22","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.diabres.2012.10.024","article-title":"Carbohydrate counting accuracy and blood glucose variability in adults with type 1 diabetes","volume":"99","author":"Brazeau","year":"2013","journal-title":"Diabetes Res Clin Pract"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251376012","article-title":"Carbohydrate counting\/bolus calculator mobile application improves time in range in adults with type 1 diabetes subjects","volume":"28","author":"Albabtain","year":"2026","journal-title":"Diabetes Technol Ther"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/176564","article-title":"Investigation on carbohydrate counting method in type 1 diabetic patients","volume":"2014","author":"Son","year":"2014","journal-title":"BioMed Res Int"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3390\/diabetology6030019","article-title":"The relationship between quality of life, diabetes distress, and metabolic control in Hungarian type 1 diabetic patients: a cross-sectional study","volume":"6","author":"Losonczi","year":"2025","journal-title":"Diabetology"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.20945\/2359-3997000000596","article-title":"Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus","volume":"67","author":"Centenaro","year":"2023","journal-title":"Arch Endocrinol Metab"},{"key":"B27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2337\/dc13-2112","article-title":"The diabetes control and complications trial\/epidemiology of diabetes interventions and complications study at 30 years: overview","volume":"37","author":"Nathan","year":"2014","journal-title":"Diabetes Care"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-1490","article-title":"Effects of carbohydrate counting on glucose control and quality of life over 24 weeks in adult patients with type 1 diabetes on continuous subcutaneous insulin infusion: a randomized, prospective clinical trial (GIOCAR)","volume":"34","author":"Laurenzi","year":"2011","journal-title":"Diabetes Care"},{"key":"B29","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1136\/bmjnph-2022-000608","article-title":"Value of carbohydrate counting","volume":"6","author":"Briggs Early","year":"2023","journal-title":"BMJ Nutr Prev Health"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-0903","article-title":"Quality of life, coping ability, and metabolic control in patients with type 1 diabetes managed by group care and a carbohydrate counting program","volume":"32","author":"Trento","year":"2009","journal-title":"Diabetes Care"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1922652\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:49:20Z","timestamp":1787719760000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1922652\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":30,"alternative-id":["10.3389\/fendo.2026.1922652"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1922652","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1922652"}}