الفهرس 
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Abstract
Carbohydrate counting is one of the dietary management approaches that can be used in the management of T1DM. It can be used by those with T1DM who use either multiple daily injections or continuous subcutaneous insulin infusion to manage their diabetes. It focuses on carbohydrates as the primary macronutrient affecting post-prandial glycemic response and is used to adjust insulin dose levels according to the carbohydrate content of the meal (Cornell et al., 2020).
Aim of the study:
The current study aimed to evaluate the effect of carbohydrate content estimation on adolescents’ glycemic control.
Research hypothesis:
The implementation of carbohydrate content estimation will affect positively on adolescents’ glycemic control.
Research setting:
The study was conducted in outpatient Children Diabetes Clinic/Children’s Hospital/Ain Shams University. The clinic is located in the 4th floor consisting of 2 rooms working from Monday to Wednesday weekly from 9 Am till 1 PM.
Subjects:
A Convenient sample include all the adolescents with type 1 diabetes using EPI Info 7 program for sample size calculation with margin of error = 10 % and at 95 % confident level, sample size of 81 adolescents with type 1 diabetes was needed (Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 2021).
Tools for data collection: (Appendix II)
Data were collected using the following tools:
Tool I: Adolescents assessment sheet (by interview): It was designed by the researcher in an Arabic language based on recent and relevant literatures and studies to assess the data as in the following parts:
Part 1: Adolescents’ characteristics: It was concerned with adolescents with type 1 diabetes characteristics (age, gender, and their educational level).
Part 2: History of the diabetes: It was concerned with past and present medical history including family history of diabetes, duration of diabetes, history of diabetes related complications, presenting manifestations at diagnosis, history of previous hospitalization, type of treatment and follow up with a nutritionist.
Part 3: Physical characteristics of adolescents: It was concerned with diabetic adolescents’ physical characteristics (weight, height and body mass index).
Part 4: Physiological characteristics of adolescents: It was concerned with assessment of blood glucose levels including pre-prandial and post-prandial blood glucose levels and glaciated hemoglobin (HbA1c).
Tool II: Ped Carb Quiz (PCQ): This tool was adopted from the ADA, (2010) to assess seven domains; four carbohydrate recognition domains and three insulin-dosing domains for diabetic adolescents (Koontz et al., 2010).
The main results of the study:
Findings of the current study can be summarized as the following:
• It was found that 46.9% of the adolescents with T1DM aged between 14 :< 16 years, 67.7% were females and 34.6% were studying at preparatory school. Also it was found that 37.1 % of them were ranked as the first child in their families and 79 % were from urban residence.
• It was found that 41 % of the adolescents with T1DM had more than 6 years duration of the disease (X̄ ±SD 6.073 ± 4.172 year), 50.6 % presented with hyperglycemic symptoms at diagnosis and 6.2 % were treated with insulin therapy and nutritional therapy. Also 49.4 % had been previously hospitalized and DKA was the cause of hospitalization among 65 % of them.
• Concerning physical characteristics of the adolescents with T1DM, the current study revealed that 60.5 % had normal body mass index while, only 4.9 % of them were obese.
• Regarding pre-prandial blood glucose of the adolescents with T1DM, the current study illustrated that X̄±SD post CCE was 124.81±18.72 mg/dL compared with X̄ ±SD 141.98±21.30 mg/dL pre CCE (p-value <0.001) and this reflected highly statistical significant difference pre/post CCE.
• As regards post-prandial blood glucose level of the adolescents with T1DM the current study revealed that X̄±SD post CCE was 190.86±28.63 mg/dL compared with X̄ ±SD 210.62±31.59 mg/dL pre CCE (p-value <0.001) and this reflected highly statistical significant difference pre/post CCE.
• Regarding HbA1c level of the adolescents with T1DM, the current study showed that X̄ ±SD of HbA1c post CCE was 10.03 ± 2.516 % compared with 9.7 ± 2.343 % pre CCE (p-value >0.05) and this revealed statistical insignificant difference pre/post CCE.
• As regards carbohydrate recognition domain among the studied adolescents with T1DM, the results illustrated that the mean total score of was 69.11 ± 9.99 post CCE compared with 42.02 ± 10.33 pre CCE (p-value <0.001) and this reflected a highly statistical significant difference pre/post CCE.
• Concerning, insulin dosing domain among the studied adolescents with T1DM, the results revealed that the total score was 22.04 ± 9.35 pre CCE compared with 60.93 ± 12.77 post CCE (p-value <0.001) and this showed a highly statistical significant difference pre/post CCE (p-value <0.001).
• Regarding the total PCQ score of adolescents with T1DM, the results revealed that the total score was 65.02±11.934 post CCE compared to 32.03±10.33 pre CCE (p-value <0.001) and this reflected a highly statistical significant difference pre/post CCE (p-value <0.001).
• There was statistical insignificant relation between characteristics and medical history of adolescents with T1DM and their Pre-prandial blood glucose level post CCE (p-value >0.05).
• There was statistical significant relation between level of education of adolescents with T1DM and their Post-prandial blood glucose level post CCE (p-value <0.05).
• There was statistical insignificant relation between medical history data of adolescents with T1DM and their post-prandial blood glucose level post CCE (p-value >0.05).
• There was statistical insignificant relation between characteristics of adolescents with T1DM and their glaciated hemoglobin level post CCE (p-value >0.05).
• There was statistical significant relation between family history for DM and duration of diabetes of adolescents with T1DM and their glaciated hemoglobin level post CCE (p-value <0.05).
• There was statistically insignificant relation between carbohydrate recognition domain of adolescents with T1DM and their characteristics and medical history data post CCE (p-value >0.05).
• There was insignificant relation between characteristics and medical history data of adolescents with type 1 diabetes and insulin dosing domain post CCE (p-value >0.05).
• There was statistically significant relation between gender of adolescents with T1DM and their total PCQ score post carbohydrate content estimation with p-value <0.05.
• There was statistically insignificant relation between medical history data of adolescents with T1DM and total PCQ score post CCE (p-value >0.05).
• There was negative correlation between adolescents with type 1 diabetes pre-prandial and post-prandial blood glucose levels and their total pre PCQ score (p-value <0.05). While there was no correlation between adolescents with T1DM HbA1c and their total pre PCQ score (p-value >0.05).