Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Foods and Nutrition


Dworatzek, Paula

2nd Supervisor

O'Connor, Colleen


Carbohydrate counting (CHO) is a nutrition education tool used by patients with type 1 diabetes mellitus (T1DM). The primary objective was to assess glycated hemoglobin (A1C) in participants with T1DM using CHO counting vs. those using a structured meal plan (SMP). The secondary objectives were to determine if BMI-for-age, parental income, parental involvement, and mothers’ educational level were associated with their children’s glycemic control. A cross sectional study was conducted, where participants aged 4-18 years, or their parents completed a survey. Total sample size was 88 participants (77 in the CHO counting group and 11 in the SMP group). There were no differences in demographic variables or A1C between the two groups. Unexpectedly, there was a very high proportion of participants in the CHO counting group; so there were few statistical differences between the groups. The qualitative data emphasized CHO counting as a challenge patients faced, especially when eating out.

Summary for Lay Audience

When people have type 1 diabetes, Registered Dietitians (RD) may encourage them to count the amount of CHO in the grains, rice, pasta, starchy vegetables, and bread they eat; this is called CHO counting. Another approach is when the RD gives patients a structured meal plan to follow with a specific amount of grains, rice, pasta, and starchy vegetables that they can have at each meal and snack. The purpose of this study was to determine if there was a difference in A1C levels of children with T1DM on the CHO counting approach vs. those on the SMP approach. A1C is a measure of the amount of sugar that sticks to hemoglobin in the red blood cells.

This study was done at Windsor Regional Hospital with patients, ages 4-18 years, who have T1DM. Parents or adolescents filled out a survey that asked questions about the patient’s health conditions, insulin schedule, meal plan, family income, and mother’s education level. Height, weight, and A1C were collected from the clinic charts. The researchers analyzed the data to look at A1C levels between patients using the two-different meal-plans and if there were any familial factors that influenced the A1C.

There was a total of 88 people in this study, 77 in the CHO counting group and 11 in the SMP group. There were no differences in the characteristics of the participants including A1C between the two groups. There was a meaningful relationship between physical activity and BMI-for-age. One of the important themes that came out of the survey was that participants found it hard to count CHOs, especially when eating out. Therefore, it is important to provide sufficient knowledge to help patients count CHOs, especially when eating away from home and at restaurants.