What effects does carbohydrate counting to manage insulin-to-food dosage calculations have on behaviours and cognitions related to food and/or disordered eating? A scoping review

Aims:
Carbohydrate counting (CC) is often assumed to contribute to the high prevalence of disordered eating behaviour (DEB) seen in patients with type 1 diabetes. The aim of this project was to evaluate evidence, and measures used to explore associations between CC in type 1 diabetes and eating behaviour and/or DEB.

Methods:
Systematic literature searches for studies including carbohydrate counting or dose adjustment for normal eating (DAFNE), and specific eating behaviours and/or disordered eating using MEDLINE, Embase, PsycINFO, Web of Science and Scopus and the trial register Cochrane Central Register of Controlled Trials were conducted and tabulated for narrative synthesis.

Results:
Thirty-seven studies were included. 93% of studies that measured CC and eating behaviours reported an association between CC and eating behaviours (e.g. eating more or less of a particular food group); or cognitions about food (e.g. diet flexibility or restriction). 28% measured CC and DEB, of which 50% (n = 4) stated that people scoring highly for DEB are less likely to use CC. Measuring CC adherence in interventions was rare (22%). Responsibility for CC was not defined in paediatric studies, and only one study examined specific CC strategies.

Conclusion:
Evidence suggests that CC does influence changes in eating behaviour. Also limited empirical research suggests that patients who exhibit DEB are less likely to use CC. Measures for CC were limited and did not adequately measure adherence, transitions from parent-led to self-led management, the spectrum of CC strategies employed, or the reasons for the adaption/rejection of CC.