1. Introduction
T1DM, mistakes, ’, dysglycemia, autoimmune disease
TYPE 2 DIABETES, TYPE 1 DIABETES MELLITUS, PATHOGENESIS, AUTOIMMUNE DISEASE, COMPLICATIONS
For patients with Type 1 diabetes mellitus (T1DM), accurate carbohydrate counting (CC) is essential for successful blood glucose regulation. Unfortunately, mistakes are common and may lead to an incorrect dosage of prandial insulin. In this work, we aim to demonstrate that each person has their own limits for CC errors, which can be computed using patient-specific data. To validate the proposed method, we tested it using several scenarios to investigate the effect of different CC errors on postprandial blood glucose. Virtual subjects from the T1DM Simulator were used in a clinical trial involving 450 meals over 90 days, all following the same daily meal plan but with different intervals for CC errors near, below, and above the limit computed for each patient. The results show that CC errors within personalized limits led to acceptable postprandial glycemic fluctuations. In contrast, experiments where 50% and 97.5% of the meals present a CC error outside the computed safe interval revealed a pronounced degradation of the time in range. Given these results, we consider the proposed method for obtaining personalized limits for CC errors an excellent starting point for an initial assessment of patients’ capabilities in CC and to provide appropriate ongoing education.Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by the destruction of pancreatic β-cells, responsible for insulin production. T1DM typically develops in childhood or early adolescence but can occur at any age. Unlike Type 2 diabetes, T1DM is not associated with lifestyle factors. While the pathogenesis of T1DM is not fully understood, it is believed to involve a combination of genetic and environmental factors. In T1DM, the immune system mistakenly targets and destroys the β-cells which leads to dysglycemia and makes the patients insulin-dependent [To avoid such complications, patients with T1DM are treated using insulin replacement regimens, requiring basal insulin and mealtime insulin to compensate for the meals’ carbohydrates (CHO) content [Thus, accurately performing CC is paramount to dose the insulin bolus and, consequently, to achieve proper BG regulation [Nevertheless, each individual has their own characteristics, such as ICR and ISF, so these generalized limits provide orientation but can be improved. For that purpose, Abreu et al., in [Based on patient-specific CC maximum errors, personalized CC educational programs can be tailored to address the needs of each patient rather than following a one-size-fits-all approach. In this way, a patient with a maximum allowable error of less than the general recommendation of 10 g should be made aware and trained more rigorously, while patients with a higher margin of error can feel more confident in performing CC and improving their treatment adherence. Indeed, knowing patients’ specific limits to CC error is crucial to improve their motivation and engagement.To the best of our knowledge, apart from the one proposed by Abreu et al. [