Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet

Lennerz, Belinda; Barton, Anna Beth; Bernstein, Richard K; Dikeman, R. David; Diulus, Carrie; Hallberg, Sarah; Rhodes, Erinn T.; Ebbeling, Cara B.; Westman, Eric; Yancy, William S.; Ludwig, David S.

doi:10.1542/peds.2017-3349

Cited by 119 publications

(137 citation statements)

References 44 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Another study described participant‐reported hypoglycaemic events, with 38% reporting one to five hypoglycaemic events per month, but 8% reporting >21 events per month. Four percent of respondents in the latter study reported glucagon use in the past year .…”

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 75%

“…Two recent observational studies , however, reported hyperlipidaemia in the majority of participants. One study with 11 participants found total cholesterol and LDL cholesterol levels were above the recommended range in most of the cohort .…”

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 92%

“…One study with 11 participants found total cholesterol and LDL cholesterol levels were above the recommended range in most of the cohort . The other study observed dyslipidaemia in the majority of respondents . These findings highlight the importance of close nutritional support if a low‐carbohydrate diet is followed to ensure healthy food choices that minimize saturated fat and increase fibre intakes.…”

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 97%

“…The studies are limited by small study size , the highly self‐selected nature of participants and confounders, such as frequent blood glucose monitoring and insulin corrections . Only one of the observational studies includes children .…”

Section: What Is the Impact Of A Low‐carbohydrate Diet On Glycaemic Omentioning

confidence: 99%

See 3 more Smart Citations

The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes

et al. 2018

View full text Add to dashboard Cite

Dietary management has been a mainstay of care in Type 1 diabetes since before the discovery of insulin when severe carbohydrate restriction was advocated. The use of insulin facilitated re‐introduction of carbohydrate into the diet. Current management guidelines focus on a healthy and varied diet with consideration of glycaemic load, protein and fat. As a result of frustration with glycaemic outcomes, low‐carbohydrate diets have seen a resurgence in popularity. To date, low‐carbohydrate diets have not been well studied in the management of Type 1 diabetes. Studies looking at glycaemic outcomes from low‐carbohydrate diets have largely been cross‐sectional, without validated dietary data and with a lack of control groups. The participants have been highly motivated self‐selected individuals who follow intensive insulin management practices, including frequent blood glucose monitoring and additional insulin corrections with tight glycaemic targets. These confounders limit the ability to determine the extent of the impact of dietary carbohydrate restriction on glycaemic outcomes. Carbohydrate‐containing foods including grains, fruit and milk are important sources of nutrients. Hence, low‐carbohydrate diets require attention to vitamin and energy intake to avoid micronutrient deficiencies and growth issues. Adherence to restricted diets is challenging and can have an impact on social normalcy. In individuals with Type 1 diabetes, adverse health risks such as diabetic ketoacidosis, hypoglycaemia, dyslipidaemia and glycogen depletion remain clinical concerns. In the present paper, we review studies published to date and provide clinical recommendations for ongoing monitoring and support for individuals who choose to adopt a low‐carbohydrate diet. Strategies to optimize postprandial glycaemia without carbohydrate restriction are presented.

show abstract

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 75%

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 92%

Section: Clinical Considerations Associated With Low‐carbohydrate Dietsmentioning

confidence: 97%

Section: What Is the Impact Of A Low‐carbohydrate Diet On Glycaemic Omentioning

confidence: 99%

See 2 more Smart Citations

The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Based on this reasoning, some people with type 1 diabetes practise low carbohydrate diets and there have been personal and observational reports of positive outcomes . However, to date scientific evidence from randomized trials in type 1 diabetes is sparse …”

Section: Introductionmentioning

confidence: 99%

Low versus high carbohydrate diet in type 1 diabetes: A 12‐week randomized open‐label crossover study

Schmidt

Christensen

Serifovski

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aims To compare the effects of a low carbohydrate diet (LCD < 100 g carbohydrate/d) and a high carbohydrate diet (HCD > 250 g carbohydrate/d) on glycaemic control and cardiovascular risk factors in adults with type 1 diabetes. Materials and methods In a randomized crossover study with two 12‐week intervention arms separated by a 12‐week washout, 14 participants using sensor‐augmented insulin pumps were included. Individual meal plans meeting the carbohydrate criteria were made for each study participant. Actual carbohydrate intake was entered into the insulin pumps throughout the study. Results Ten participants completed the study. Daily carbohydrate intake during the two intervention periods was (mean ± standard deviation) 98 ± 11 g and 246 ± 34 g, respectively. Time spent in the range 3.9‐10.0 mmol/L (primary outcome) did not differ between groups (LCD 68.6 ± 8.9% vs. HCD 65.3 ± 6.5%, P = 0.316). However, time spent <3.9 mmol/L was less (1.9 vs. 3.6%, P < 0.001) and glycaemic variability (assessed by coefficient of variation) was lower (32.7 vs. 37.5%, P = 0.013) during LCD. No events of severe hypoglycaemia were reported. Participants lost 2.0 ± 2.1 kg during LCD and gained 2.6 ± 1.8 kg during HCD (P = 0.001). No other cardiovascular risk factors, including fasting levels of lipids and inflammatory markers, were significantly affected. Conclusions Compared with an intake of 250 g of carbohydrate per day, restriction of carbohydrate intake to 100 g per day in adults with type 1 diabetes reduced time spent in hypoglycaemia, glycaemic variability and weight with no effect on cardiovascular risk factors.

show abstract

Diabetes in Childhood

Ikle,

Addala,

Maahs

2024

Textbook of Diabetes

View full text Add to dashboard Cite

Management of Type 1 Diabetes With a Very Low–Carbohydrate Diet

Abstract: Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.

Cited by 119 publications

References 44 publications

The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes

The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes

Low versus high carbohydrate diet in type 1 diabetes: A 12‐week randomized open‐label crossover study

Diabetes in Childhood

Contact Info

Product

Resources

About