OBSERVATIONS Quality of Life, Coping Ability, and Metabolic Control in Patients With Type 1 Diabetes Managed

G roup care is a clinical-pedagogicmodel in which traditional routinevisits are substituted by sessions of group education. This approach im-proves quality of life and metabolic con-trol in patients with type 2 diabetes (1) but only quality of life in those with type 1 diabetes (2). The latter must match mul-tiple daily insulin administrations with blood glucose monitoring, dietary intake, and energy expenditure (3). We hypoth-esized that to improve their coping strat-egies, patients with type 1 diabetes need more specific training in the technical as-pects of day-to-day management of insu-lin therapy. To verify this, we studied the effects of embedding a carbohydrate counting program within group care on quality of life, knowledge of diabetes, coping ability, and metabolic control. Of 56 patients with type 1 diabetes already followed by group care, 27 were randomized to receive an eight-session carbohydrate counting program and 29 continued a more generic curriculum (control subjects). Inclusion criteria were: age 70 years, onset of diabetes before age 30 years, and having started insulin treatment within 1 year of diagnosis. All patients were on four-daily injections and self-monitored blood glucose. None re-fused to participate, and all gave their in-formed consent to the study, which conformed with the principles of the Hel-sinki Declaration. Quality of life, knowl-edge, and coping ability were measured by questionnaires (1,4) at baseline and af-ter 30 months. A1C, body weight, blood glucose, hypoglycemic episodes, and in-sulin dosages were checked every 3 months. All patients completed the study. Compared with baseline, the quality of life score improved (P 0.0001) in both the patients on the carbohydrate countin