A feasibility study of carbohydrate counting and flexible insulin dosing in adults with type 2 diabetes: MATCH IT (MAtching Treatment to CarboHydrate in Insulin-treated type Two diabetes

Abstract

Diabetes mellitus is a chronic condition which is associated with serious microvascular and macrovascular complications and diminshed quality of life. Intenstive glycaemic control has been shown to reduce the incidence of diabetes-related complications in people with type 2 diabetes mellitus (T2DM) but can further decrease quality of life. Carbohydrate counting and flexible insulin dosing is known to improve glycaemic control and quality of life in adults with type 1 diabetes (T1DM). Limited evidence suggests that this diabetes management method can also reduce glycosylated haemoglobin (HbA1c) in people with type 2 diabetes (T2DM) using prandial insulin (Bergenstal et al., 2008) but this has not been investigated rigorously and no studies have investigated the impact on psychosocial outcomes. Does insulin dose adjustment in line with mealtime carbohydrare intake in adults with T2DM using prandial insulin improve the primary outcomes HbA1c and quality of life? Impact on secondary outcomes including treatment satisifaction and vascular risk facors was also assessed. A feasibility study, using a randomished controlled delayed start (waiting list) trial design, was conducted. Adults with T2DM using prandial insulin were trained to count carbohydrates and adjust insulin doses through group education sessions. Carbohydrate counting and flexible insulin dosing in adults with T2DM was found to be non-inferior to static dosing insulin regimes, and was associated with improved quality of life and reduced perception of hypoglycaemia. This was associated with non-significant reducations in body weight, waits circumference and total daily insulin dose and was achieved despite increased dietary freedom, and without significane deterioration in other vascular risk factors. This management method has the potential to improve quality of life whilst maintaining or optimising glycaemic control in individuals with T2DM who require a variable insulin regime. This rising incidence of T2DM, its economic and health burden, and the increasingly younger patient profile make these findings particularly pertinenet. Further research is warranted to explore these initial findings.