Improved glycemic control in type 1 diabetes with very low-carbohydrate diets
1. A survey of individuals with type 1 diabetes mellitus (T1DM) consuming a very low-carbohydrate diet (VLCD) indicated that many study participants were able to maintain glycemic control within national ideal glycemic target ranges.
2. Complications, including hospitalizations for ketoacidosis and hypoglycemia, were rare in the study population.
Study Rundown: Proper nutrition is an important part of standard diabetes management. Carbohydrates in particular have a significant effect on serum blood glucose, which in turn is a main contributor to the HbA1c, a measure of glycemic control in diabetics. The study sheds light on the potential benefit and safety of the VLCD, which is defined as a diet restricted to ≤ 20-50g of carbohydrates per day. Study participants from a Facebook group for individuals with T1DM who follow a carbohydrate-restricted diet were surveyed regarding insulin regimens, diabetes diagnosis, and provider-patient relationships among other topics. Type 1 diabetes diagnosis was inferred via the responses. Survey results were corroborated via medical provider data. Results indicated that the average HbA1c of the participants was lower than the proposed national benchmark produced by the American Diabetes Association. Adverse events, such as hospitalizations for diabetes-related complications, were rare. While this study design is limited by potential selection bias, results suggest that patients may benefit from VLCD adoption. Further study is needed to confirm the efficacy and safety of this treatment approach.
Relevant Reading: Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review
Study author, Belinda Lennerz, MD PHD, speaks to 2 Minute Medicine: Instructor in pediatric endocrinology at Boston Children's Hospital and Harvard Medical School.
“The normal blood glucose control without increase in hypoglycemia rates or other acute diabetes complications are typically thought to be unachievable in type one diabetes. The findings point toward carbohydrate restriction as a possible adjunct in type one diabetes management, an approach that is typically not considered.”
In-Depth [survey]: This study incorporated a survey along with biometric data on patients who subscribe to a VLCD and likely have T1DM. Data on diabetes diagnosis,insulin regimens, diabetic complications, and general health were collected from a primary online survey of volunteer patients who are part of the VLCD Facebook community “TypeOneGrit.” A secondary survey of medical care providers who cared for the participants was also sought. Out of 316 participants (57% female, 42% children) in the analysis, only 138 had follow-up medical survey data gathered. The mean amount of time participants committed to this lifestyle was 2.2 + 3.9 years. A total of 97% of participants in the study met national guidelines with regards to the ideal glycemic range, defined as HbA1c <7.5% for children and <7% for adults. On average, HbA1c decreased by 1.45% + 1.04% (p < 0.001), as reported by participants, following VLCD initiation. Only 1% of patients reported hypoglycemia resulting in hospitalization.
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