Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: An 18-month observational study Ivana Rabbone a , Andrea E. Scaramuzza b, *, Maria Giovanna Ignaccolo a , Davide Tinti a , Sabrina Sicignano a , Francesca Redaelli b , Laura De Angelis b , Alessandra Bosetti b , Gian Vincenzo Zuccotti b , Franco Cerutti a a Department of Paediatrics, University of Turin, Piazza Polonia, 94, 10126 Turin, Italy b Department of Paediatrics, Azienda Ospedaliera, University of Milano, ‘‘Ospedale Luigi Sacco’’, via G.B. Grassi 74, 20157 Milano, Italy d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 0 3 ( 2 0 1 4 ) 3 8 8 – 3 9 4 a r t i c l e i n f o Article history: Received 26 July 2013 Received in revised form 22 October 2013 Accepted 21 December 2013 Available online 3 January 2014 Keywords: Bolus calculator Carbohydrate counting Childhood diabetes Education Insulin therapy Type 1 diabetes a b s t r a c t Aims: This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections. Methods: We evaluated 85 children, aged 9–16 years, with type 1 diabetes, divided into four groups: controls (n = 23), experienced carbC (n = 19), experienced carbC + ABC (n = 18) and non-experienced carbC + ABC (n = 25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability – evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) – were assessed at baseline and after 6 and 18 months. Results: At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p = 0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly – patients using ABC (according to manufacturer’s recommendations) HbA1c 7.14  0.41% at 6 months vs. 7.35  0.53% at baseline, (p = 0.136) or without carbC experience HbA1c 7.61  0.62% vs. 7.95  0.99% (p = 0.063). Patients using ABC had a better HBGI (p = 0.001) and a slightly worse LBGI (p = 0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (0.42% from baseline; p = 0.018). Conclusions: CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC. # 2013 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Pediatrics, University of Milano, Luigi Sacco Hospital, Via Giovanni Battista Grassi 74, 20157 Milano, Italy. Tel.: +39 0239042791; fax: +39 0239042254. E-mail address: scaramuzza.andrea@hsacco.it (A.E. Scaramuzza). Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.diabres.2013.12.026