Low-carbohydrate diet to treat type i diabetes in children

Relation

Lennerz BS, Barton A, Bernstein RK, et al. Management of type 1 diabetes with a very low-carbohydrate diet.Pediatrics. 2018; 141 (6): E20173349.

Objective

To characterize glycemic control; Determine disadvantageous events; Assessment of objective health characteristics (weight, blood parameters, etc.); Compare the pre- and post-parameters of glycemic control with the introduction of a VLCD diet; And characterize the satisfaction of the participants with both diabetes management and the health system.

Draft

Cross-sectional observational cohort study using an online survey of members of a social media support group

Participant

All participants were members of an international social media group for people with type 1 diabetes mellitus (T1DM), which adhere to a very low-carbohydrate diet (VLCD). A total of 316 people took part in the survey. Of the 316 respondents, there were 273 references to T1DM, 131 were parents with children with T1DM, 57 % were female, 42 % were children, 88 % were white and non-Hispanians and 84 % had a university degree. The middle age in diagnosis was 16 ± 14 years, the average duration of the diabetes was 11 ± 13 years and the medium duration that they followed a VLCD was 2.2 ± 3.9 years.

Study parameters rated

The survey asked questions about: daily dietary carbohydrate intake; diabetes-related complications and hospitalizations in the past year, particularly for ketoacidosis or hypoglycemia; average daily total insulin dose; blood glucose concentrations measured with a continuous glucose monitor or glucose meter; side effects; weight/height/BMI; Metabolism laboratories (serum lipids); patient-doctor relationship; and hemoglobin (Hb)A_1c(Glycosylated hemoglobin). Confirming data was received by diabetes supervisors or medical records.

Primary result measurement

HBA change_1cAfter the start of VLCD

Key insights

An extraordinary glycemic control of T1DM with low side effect rates was reported by a community of children and adults who received a VLCD. The average daily carbohydrate intake was 36 ± 15 grams per day and the average HBA_1cwas 5.6 % ± 0.66 %. Almost 97 % of the participants achieved the glycemic goals of the American Diabetes Association (ADA).

The results of this observation study with T1DM participants are exceptionally positive compared to the results of conventional care locations.

The participants saw their HBA_1care on average by -1.45 ± -1.04 %. Although only a few participants had to be hospitalized for hypoglycaemia (2 %) or ketoacidosis (1 %), symptomatic hypoglycaemia was much more common; 69 % of the patients surveyed stated that the majority (55 %) reported 1 to 5 episodes per month in the month before the survey was completed.

Practice implications

The results of this observation study on T1DM participants are extremely positive compared to the results of conventional treatment cohorts. According to a report from 2015 from a large database, the conventional treatment of T1DM patients leads to an average HBA_1cof 8.2 %, and only 20 % of children and 30 % of adults reach the target HBA_1c-Walems (ada glycemic goals).¹

A problematic statement of 27 % of VLCD supporters in the present study was that they did not tell the diabetics that they followed a VLCD. For those who shared, less than half believed that their practitioners supported their choice of diet. For naturopathic practitioners/integrative practitioners who are familiar with a low-carbohydrate diet of their diabetics and support them much more openly, a better doctor-patient relationship can undoubtedly be promoted and maintained.

In view of the fact that diabetes could be defined as a "loss of metabolic capacity to process carbohydrates due to insulin resistance or lack of produced insulin", the restriction of carbohydrates in dietary treatment is both healthy and medically sensible.

However, a survey is not the strictest example of medical validation. The implementation of the survey via a social media platform could rule out those who have not achieved good results because they may have got out of the group or simply did not complete the survey. Those who are successful with a certain treatment may be more motivated than others to share experience. However, there has been a more formal review of the topic in order to support the observations found in this study.

A study by Richard Feinman and colleagues from 2015 entitled "Dietary Carbohydrate Restriction as The First Approach in Diabetes Management: Critical Review and Evidence Base" brought together numerous studies that clearly show that diabetes are best treated with a low carbohydrate content and should be treated first.²This 12-point medical review analyzed the positive results of many studies showing that carbohydrate restriction in the diet reduces high blood sugar, does not require weight loss (although it is excellent for weight loss), and leads to the reduction or elimination of medications. The review analyzed VLCD studies relevant to both type 2 and type 1 patients.

Every naturopathic doctor who works with diabetics should concentrate on making his patients known from all food sources (and supporting compliance) with a VLCD of less than 40 grams a day. The start of treatment with this protocol is the basis for successful glucose control in our patients with diabetes.