Effects of carbohydrate counting training versus standard nutritional and medical therapy on glycemic control and sarcopenia in type 2 diabetes: an open-label randomized controlled trial

Abstract Introduction Carbohydrate counting training is recommended for patients with type 1 diabetes as it has been proved to be effective in providing glycemic control. However, there is limited evidence of this training on glycemic control in patients with type 2 diabetes. Furthermore, there is limited knowledge on presence of sarcopenia in this group. Objective To examine sarcopenia in patients with type 2 diabetes receiving intensive insulin therapy and evaluate the effect of carbohydrate counting training on clinical findings related to diabetes and sarcopenia. Method A 24-week randomized controlled trial was conducted on 58 individuals with type 2 diabetes receiving intensive insulin therapy (59.81 ± 10.24 years, HbA1c level: 9.42 ± 1.73%). Participants were randomly divided into two groups: control (standard medical and nutrition treatment) and training (advanced carbohydrates counting training in addition to standard treatment). Results Daily prandial insulin doses decreased in the training group compared to baseline ( p = 0.034). The frequency of hypoglycemia and hyperglycemia decreased significantly ( p = 0.007 and p = 0.001, respectively). HbA1c levels in the training group decreased by 1.04 ± 1.01% and 1.56 ± 1.35% at weeks 12 and 24, respectively. Although a significant time-by-group interaction was observed, post-hoc comparisons were not significant after Bonferroni correction. A significant decrease was found in body weight, Body Mass Index (BMI) and muscle mass in the training group. Hand grip test conducted on all participants indicated 19.0% to have low muscle strength. Conclusion Advanced carbohydrate counting training was associated with improvements in glycemic parameters in individuals with type 2 diabetes receiving intensive insulin therapy. However, given the lack of significant post-hoc differences and the study’s limitations, the findings should be interpreted cautiously. Of the participants, 19.0% exhibited probable sarcopenia based on low handgrip strength.