Medical management of children with type 1 diabetes on low-carbohydrate or ketogenic diets

Amy A Rydin, Gail Spiegel, Brigitte I Frohnert, Anne Kaess, Lauren Oswald, Darcy Owen, Kimber M Simmons, Amy A Rydin, Gail Spiegel, Brigitte I Frohnert, Anne Kaess, Lauren Oswald, Darcy Owen, Kimber M Simmons

Abstract

Objectives: Low-carbohydrate and ketogenic diets are becoming increasingly popular choices for people with type 1 diabetes (T1D) aiming to achieve optimal glycemic control. A carbohydrate-restricted diet in children has been associated with negative health effects including poor linear growth and inadequate bone mineralization. Guidelines for monitoring children and adolescents choosing to follow a carbohydrate-restricted diet do not exist. We aimed to create a clinical protocol outlining how to clinically and biochemically follow patients choosing a carbohydrate-restricted diet with the goal of medical safety.

Methods: An interdisciplinary committee was formed and reviewed current consensus guidelines for pediatric patients on carbohydrate-restricted diets for epilepsy and metabolic disorders. A literature search was done to determine management strategies for children with T1D on a low-carbohydrate or ketogenic diet. Key health parameters that require monitoring were identified: growth, glycemic control, bone health, cardiometabolic health, and nutritional status. These health outcomes were used to develop a protocol for monitoring children on carbohydrate-restricted diets.

Results: A one-page protocol for medical providers and educational materials for families interested in following a low-carbohydrate or ketogenic diet were developed and successfully implemented into clinical care.

Conclusion: Implementing a protocol for children on carbohydrate-restricted diets in clinic allows medical providers to ensure medical safety while being open to discussing a family's dietary preferences. Following children in the protocol over time will lead to informed clinical guidelines for patients with T1D who choose to follow a carbohydrate-restricted diet.

Keywords: carbohydrate-restricted diet; ketogenic diet; pediatrics; type 1 diabetes mellitus.

Conflict of interest statement

CONFLICT OF INTEREST

The authors have no relevant conflicts of interest to disclose.

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Clinical protocol for monitoring children on low-carbohydrate diet. CGM, continuous glucose monitor;
FIGURE 2
FIGURE 2
Risks of a carbohydrate-restricted diet. T1D, type 1 diabetes

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