Simplifying carb counting: A randomized controlled study - Feasibility and efficacy of an individualized, simple, patient-centred carb counting tool.

INTRODUCTION: The purpose of this study was to introduce and test a simple, individualized carbohydrate counting tool designed for persons with Type 1 Diabetes Mellitus (T1DM) in order to determine whether the tool improved A1C levels for participants with age, education or language barriers. METHODS: In a randomized controlled trial, 85 participants were offered six diabetes instructional sessions free of charge over a six-month period. Forty-one received guidance using the regular carbohydrate counting (RCC) method. Forty-four received guidance using an individualized 'Simple Carb Counting' (SCC), involving two customized tables prepared for participants. RESULTS: The simple, individualized SCC tool for carbohydrate counting was non-inferior to the standard method of RCC. The SCC tool was more effective among participants aged 40 and older, while no differences were found when comparing participants by education level. Irrespective of intervention group, all participants improved their A1C level (9.9% = 13.2 mmol/L vs 8.6% = 11.1 mmol/L, p = .001). A greater improvement in A1C level was seen in newly diagnosed participants (-6.1 vs -0.7, p = .005, -3.4 vs 0.9, p = .032) in both the RCC and SCC groups. All participants expressed improved emotional level per their PAID5 questionnaires (Problem Areas in Diabetes Scale-PAID), (10.6 (±5.7) vs 9.5 (±5.7), p = .023), with women reporting greater improvement than men. CONCLUSIONS: SCC is a simple, individualized, feasible, low-tech tool for carbohydrate counting, which promotes and enables accurate insulin dosing in people with T1DM. It was found more effective among participants aged 40 and older. Additional studies are needed to corroborate these findings.

[Streptococcal pharyngitis among children: comparison of attitudes between family physicians and pediatricians].

BACKGROUND: Streptococcal pharyngitis is a common problem among children and adolescents. There are differences in diagnostic and treatment approaches in streptococcal pharyngitis between family physicians and pediatricians. To our knowledge, this issue has not been investigated in Israel. OBJECTIVE: To evaluate the attitude to diagnosis and treatment of streptococcal pharyngitis among family physicians and pediatricians in the southern part of Israel, and to explore the possible differences between these two populations. METHODS: The study population consisted of a convenience sample of family physicians and pediatricians employed by Clalit Health Services in the Negev area. Anonymous questionnaires were self-administered to family physicians during clinic staff meetings or during participation in courses. The study included pediatricians working at Soroka University Medical Center and in the Negev community clinics. RESULTS: The study included 52 family physicians and 50 pediatricians. The majority of the participants correctly evaluated the criteria for streptococcal pharyngitis (93%). A statistically significant difference (p<0.01) was found comparing the treatment approach of the two physician groups. Twenty seven family physicians (51.9%) begin empiric antibiotic treatment in cases with high probability of streptococcal pharyngitis, compared with only nine (18.8%] pediatricians. In this case, the majority of pediatricians prefer to complete the Laboratory tests. Remarkable difference was found regarding the treatment approach. All the family physicians (100%) in the study recommended Rafapen treatment compared with twenty seven (57.4%) of the pediatricians (p<0.0001). CONCLUSIONS: It appears to be appropriate to plan and perform a large national study in order to formulate uniform guidelines for streptococcal pharyngitis.