AdultCarbQuiz for the portuguese population with type 1 diabetes mellitus: translation, cultural adaptation and validation of its metabolic impact

Abstract

Abstract Background: In type 1 diabetes mellitus (T1DM), functional insulin therapy, based on carbohydrate (CH) counting and individualized insulin-to-carbohydrate ratio, is essential to achieve an adequate metabolic control. However, to date, few tools have been validated to assess patients' knowledge about CH counting, with the AdultCarbQuizquestionnaire having proved to be a reliable method in an American cohort. The aim of this study was, therefore, to translate, culturally adapt and validate the AdultCarbQuiz questionnaire for the Portuguese population. Methods: Cross-sectional study of patients with T1DM on functional insulin therapy through continuous subcutaneous insulin infusion (CSII) followed in the Endocrinology department of a tertiary center. Prior to its application, the AdultCarbQuiz questionnaire was translated and culturally adapted to the Portuguese context. Statistical analysis was performed using the SPSS® software, v.27, with p values < 0.05 being considered significant. Results: 100 patients were included, 58% of female sex, with a mean age of 31.09 ± 10.77 years. Mean disease duration was 15.04 ± 9.23 years and mean CSII usage time was 4.02 ± 3.90 years. The average value of glycated haemoglobin (HbA1c), Time In Range (TIR), Time Above Range (TAR) and Time Below Range (TBR) was, respectively, 7.32 ± 0.87, 59.75 ± 14.13, 34.38 ± 15.40 and 5.75 ± 6.58%. The average score of the questionnaire was 30.86 points ± 3.58 points, considered high. The Kuder-Richardson 20 coefficient value was 0.63 for the total score, with a Spearman-Brown value for the half-split of 0.63. Individuals with lower HbA1c values scored significantly higher on knowledge about hypoglycemia prevention and correction (r = - 0.269, p = 0.007) and on the total questionnaire score (r = - 0.205, p = 0.041). A higher TIR and a lower TAR were also associated with a higher total score (r = 0.274, p = 0.007 and r = - 0.274, p = 0.007, respectively). Conclusion: In this study, the AdultCarbQuizquestionnaire, translated and culturally adapted to the Portuguese context, proved to be a useful tool in assessing knowledge about CH counting in patients with T1DM, allowing to optimize, individually, the therapeutic strategy in consultation.