AIM: To determine whether people with type 1 diabetes (T1D) initiating glucose sensor monitoring experience greater improvements in HbA1c when provided with education on carbohydrate counting and flexible insulin dosing than those who do not receive nutrition education. MATERIALS AND METHODS: Our retrospective observational study included 329 people with T1D initiating glucose sensor monitoring between 2015 and 2021. The participants were divided into two groups: one group attended at least one structured educational session with a registered dietitian (n = 126), while the other group did not receive structured education (n = 203). After 12 months of glucose sensor initiation, we compared glycaemic outcomes and CGM metrics between the two groups. RESULTS: At glucose sensor initiation, both groups with and without education had similar HbA1c levels (7.64% [60.0 mmol/mol] vs. 7.66% [60.2 mmol/mol]). After twelve months, the education group demonstrated greater improvement in glycemic outcomes (HbA1c 7.17% [54.9mmol/mol] vs. 7.37% [57.1 mmol/mol], p < 0.05) and spent significantly more time in the target range than did the group without structured education (68.8% vs. 64.1%, p < 0.05). We observed an inverse correlation between the number of completed educational sessions and HbA1c after 12 months, as well as between the number of educational sessions and the change in HbA1c. CONCLUSIONS: People with T1D who initiated glucose sensor monitoring alongside nutrition education showed greater improvements in HbA1c and increased time spent in the target glucose range compared to individuals who did not receive structured education. TRAIL REGISTRATION: ClinicalTrials.gov identifier: NCT06264271.

3rd Department of Internal Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Internal Medicine Masaryk Hospital Ústí nad Labem Czech Republic

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Beck R. W., Bergenstal R. M., Laffel L. M., and Pickup J. C., “Advances in Technology for Management of Type 1 Diabetes,” Lancet 394, no. 10205 (2019): 1265–1273. PubMed

Sherwood J. S., Russell S. J., and Putman M. S., “New and Emerging Technologies in Type 1 Diabetes,” Endocrinology and Metabolism Clinics of North America 49, no. 4 (2020): 667–678. PubMed PMC

Mauri A., Schmidt S., Sosero V., et al., “A Structured Therapeutic Education Program for Children and Adolescents With Type 1 Diabetes: An Analysis of the Efficacy of the “Pediatric Education for Diabetes” Project,” Minerva Pediatrica 73, no. 2 (2021): 159–166. PubMed

DAFNE Study Group , “Training in Flexible, Intensive Insulin Management to Enable Dietary Freedom in People With Type 1 Diabetes: Dose Adjustment for Normal Eating (DAFNE) Randomised Controlled Trial,” BMJ 325 (2002): 746. PubMed PMC

Fu S., Li L., Deng S., Zan L., and Liu Z., “Effectiveness of Advanced Carbohydrate Counting in Type 1 Diabetes Mellitus: A Systematic Review and Meta‐Analysis,” Scientific Reports 14, no. 6 (2016): 37067. PubMed PMC

Builes‐Montano C. E., Ortiz‐Cano N. A., Ramirez‐Rincon A., and Rojas‐Henao N., “Efficacy and Safety of Carbohydrate Counting Versus Other Forms of Dietary Advice in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta‐Analysis of Randomised Clinical Trials,” Journal of Human Nutrition and Dietetics 35, no. 6 (2022): 1030–1042. PubMed

Shearer A., Bagust A., Sanderson D., Heller S., and Roberts S., “Cost‐Effectiveness of Flexible Intensive Insulin Management to Enable Dietary Freedom in People With Type 1 Diabetes in the UK,” Diabetic Medicine 21, no. 5 (2004): 460–467. PubMed

Burghardt K., Müller U. A., Müller N., et al., “Adequate Structured Inpatient Diabetes Intervention in People With Type 1 Diabetes Improves Metabolic Control and Frequency of Hypoglycaemia,” Experimental and Clinical Endocrinology & Diabetes 128, no. 12 (2020): 796–803. PubMed

Vaz E. C., Porfirio G. J. M., Nunes H. R. C., and Nunes‐Nogueira V. D. S., “Effectiveness and Safety of Carbohydrate Counting in the Management of Adult Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta‐Analysis,” Archives of Endocrinology and Metabolism 62, no. 3 (2018): 337–345. PubMed PMC

Foster N. C., Beck R. W., Miller K. M., et al., “State of Type 1 Diabetes Management and Outcomes From the T1D Exchange in 2016–2018,” Diabetes Technology & Therapeutics 21, no. 2 (2019): 66–72. PubMed PMC

American Diabetes Association Professional Practice Committee , “7. Diabetes Technology: Standards of Care in Diabetes‐2024,” Diabetes Care 47, no. Suppl 1 (2024): 126–144. PubMed

Elbalshy M., Haszard J., Smith H., et al., “Effect of Divergent Continuous Glucose Monitoring Technologies on Glycaemic Control in Type 1 Diabetes Mellitus: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials,” Diabetic Medicine 39, no. 8 (2022): e14854. PubMed PMC

Dicembrini I., Cosentino C., Monami M., Mannucci E., and Pala L., “Effects of Real‐Time Continuous Glucose Monitoring in Type 1 Diabetes: A Meta‐Analysis of Randomized Controlled Trials,” Acta Diabetologica 58, no. 4 (2021): 401–410. PubMed

Maiorino M. I., Signoriello S., Maio A., et al., “Effects of Continuous Glucose Monitoring on Metrics of Glycemic Control in Diabetes: A Systematic Review With Meta‐Analysis of Randomized Controlled Trials,” Diabetes Care 43, no. 5 (2020): 1146–1156. PubMed

Boucher S. E., Gray A. R., Wiltshire E. J., et al., “Effect of 6 Months of Flash Glucose Monitoring in Youth With Type 1 Diabetes and High‐Risk Glycemic Control: A Randomized Controlled Trial,” Diabetes Care 43, no. 10 (2020): 2388–2395. PubMed

Bolinder J., Antuna R., Geelhoed‐Duijvestijn P., Kröger J., and Weitgasser R., “Novel Glucose‐Sensing Technology and Hypoglycaemia in Type 1 Diabetes: A Multicentre, Non‐Masked, Randomised Controlled Trial,” Lancet 388, no. 10057 (2016): 2254–2263. PubMed

American Diabetes Association , “6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes‐2024,” Diabetes Care 47, no. Suppl 1 (2024): 111–125. PubMed PMC

American Diabetes Association , “5. Facilitating Positive Health Behaviors and Well‐Being to Improve Health Outcomes: Standards of Care in Diabetes‐2024,” Diabetes Care 47, no. Suppl 1 (2024): 77–110. PubMed PMC

Battelino T., Alexander C. M., Amiel S. A., et al., “Continuous Glucose Monitoring and Metrics for Clinical Trials: An International Consensus Statement,” Lancet Diabetes and Endocrinology 11, no. 1 (2023): 42–57, 10.1016/S2213-8587(22)00319-9. PubMed DOI

Gokosmanoglu F. and Onmez A., “Influence of Flexible Insulin Dosing With Carbohydrate Counting Method on Metabolic and Clinical Parameters in Type 1 Diabetes Patients,” Open Access Macedonian Journal of Medical Sciences 6, no. 8 (2018): 1431–1434. PubMed PMC

Kluemper J. R., Smith A., and Wobeter B., “Diabetes: The Role of Continuous Glucose Monitoring,” Drugs Context 14, no. 11 (2022): 9–13. PubMed PMC

Hermanns N., Ehrmann D., Schipfer M., Kroger J., Haak T., and Kulzer B., “The Impact of a Structured Education and Treatment Programme (FLASH) for People With Diabetes Using a Flash Sensor‐Based Glucose Monitoring System: Results of a Randomized Controlled Trial,” Diabetes Research and Clinical Practice 150 (2019): 111–121. PubMed

Yoo J. H., Kim G., Lee H. J., Sim K. H., Jin S. M., and Kim J. H., “Effect of Structured Individualized Education on Continuous Glucose Monitoring Use in Poorly Controlled Patients With Type 1 Diabetes: A Randomized Controlled Trial,” Diabetes Research and Clinical Practice 184 (2022): 109209. PubMed

Skoufalos A., Thomas R., Patel R., Mei C., and Clarke J. L., “Continuous Glucose Monitoring: An Opportunity for Population‐Based Diabetes Management,” Population Health Management 25, no. 5 (2022): 583–591. PubMed

Yapanis M., James S., Craig M. E., O'Neal D., and Ekinci E. I., “Complications of Diabetes and Metrics of Glycemic Management Derived From Continuous Glucose Monitoring,” Journal of Clinical Endocrinology and Metabolism 107, no. 6 (2022): e2221–e2236. PubMed PMC

Christie D., Thompson R., Sawtell M., et al., “Structured, Intensive Education Maximising Engagement, Motivation and Long‐Term Change for Children and Young People With Diabetes: A Cluster Randomised Controlled Trial With Integral Process and Economic Evaluation—The CASCADE Study,” Health Technology Assessment 18, no. 20 (2014): 1–202. PubMed PMC

McCall A. L., Lieb D. C., Gianchandani R., et al., “Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline,” Journal of Clinical Endocrinology and Metabolism 108, no. 3 (2023): 529–562. PubMed

ISCHIA Study Group , “Prevention of Hypoglycemia by Intermittent‐Scanning Continuous Glucose Monitoring Device Combined With Structured Education in Patients With Type 1 Diabetes Mellitus: A Randomized, Crossover Trial,” Diabetes Research and Clinical Practice 195 (2023): 110147. PubMed

Suzuki S., Tone A., Murata T., et al., “Protocol for a Randomized, Crossover Trial to Decrease Time in Hypoglycemia by Combined Intervention of the Usage of Intermittent‐Scanning Continuous Glucose Monitoring Device and the Structured Education Regarding Its Usage: Effect of Intermittent‐Scanning Continuous Glucose Monitoring to Glycemic Control Including Hypoglycemia and Quality of Life of Patients With Type 1 Diabetes Mellitus Study (ISCHIA Study),” Tokai Journal of Experimental and Clinical Medicine 46, no. 2 (2021): 59–68. PubMed

Iqbal A. and Heller S. R., “The Role of Structured Education in the Management of Hypoglycaemia,” Diabetologia 61, no. 4 (2018): 751–760. PubMed PMC

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ClinicalTrials.gov
NCT06264271