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

Abstract

Objectives: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD).

Methods: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records.

Results: Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia.

Conclusions: 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.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Bernstein reported receiving royalties for books on the management of diabetes (which were used by members of the online social media group surveyed in this study). Dr Hallberg reported stock options and research support from Virta Health, a company that provides health care services for type 2 diabetes, and consulting fees from Atkins. Dr Rhodes is the site principal investigator in clinical trials for pediatric type 2 diabetes that are sponsored by Merck and AstraZeneca. Dr. Westman has ownership interest in companies using low-carbohydrate principles, and he receives royalties for books related to low-carbohydrate diets. Dr Ludwig reported receiving royalties from books on nutrition and obesity; the other authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2018 by the American Academy of Pediatrics.

Figures

FIGURE 1

Enrollment. a The primary end point, current HbA1c, was available in the appropriate time frame (at least 3 months after starting the VLCD) for 300 participants. Data from all 316 eligible participants are included in the other analyses.

FIGURE 2

HbA1c distribution. The adult (light gray) and pediatric (dark gray) age groups are shown (n = 300).