Does meal‐time insulin dosing based on fat‐protein counting give positive results in postprandial glycaemic profile after a high protein‐fat meal in adolescents with type 1 diabetes: a randomised controlled trial

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Abstract Background The present study investigated the effects of fat‐protein (CFP) counting in addition to carbohydrate (CARB) counting for calculating prandial insulin dosage on blood glucose profile in patients with type 1 diabetes (T1D) on basal‐bolus insulin therapy. Methods In this single centre, cross‐over, randomised, controlled study, control meal (SM: standard meal using a carbohydrate counting method) and three test meals (HPM: high protein meal using a carbohydrate counting method; HPFM‐a: high protein‐fat meal using a carbohydrate counting method; HPFM‐b: high protein‐fat meal using a carbohydrate and fat‐protein counting method) were compared on postprandial early (0–120 min), late (120–240 min) and total (0–240 min) glucose response in 30 patients with T1D, aged 16–18 years. Results The glucose levels of 0–90 min did not change after different meal consumptions (P > 0.05), whereas 120–240 min glucose levels were higher after HPFM‐a consumption compared to HPFM‐b consumption (P < 0.05). There were no significant differences between meals with respect to the early postprandial glucose response (0–120 min) (P = 0.405). In late response (120–240 min), HPFM‐b [area under the curve (AUC) = 20 609 (582) mg dL−1 × dk] was significantly lower than SM [AUC = 24 092 (9015) mg dL−1 × dk], HPM [AUC = 24 072 (5853) mg dL−1 × dk] and HPFM‐a [AUC = 25 986 (6979) mg dL−1 × dk] (P = 0.032). Conclusions Meal‐related insulin dosing based on carbohydrate plus fat/protein counting has given positive results in the postprandial glycaemic profile as a result of lower postprandial glycaemic levels compared to conventional carbohydrate counting in patients with T1D after a high protein‐fat meal.