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reference
Kleiner A, Cum B, Pisciotta L, et al. Safety and effectiveness of the eucaloric very low carbohydrate diet (EVLCD) in type 1 diabetes: a one-year real-life retrospective experience.Nutrients. 2022;14(15):3208.
Study objective
To find out whether switching patients with type 1 diabetes mellitus (T1DM) from a high-carbohydrate/low-fat diet to a eucaloric, low-carbohydrate, high-fat and moderate-protein diet would affect their diabetes control, insulin use, etc. lipids
Key to take away
This retrospective case study showed that a eucaloric, low-carbohydrate diet significantly reduced hemoglobin A levels1Cthe use of insulin and LDL (low density lipoprotein) levels in patients with type 1 diabetes without causing undesirable side effects.
design
Retrospective case series of T1DM patients treated at a single clinic
Participant
The study included 33 T1DM patients on insulin therapy; 23 were female. The average age was 41.6 years and the average time with diabetes was approximately 14.3 years. No exclusion criteria were listed in the publication.
intervention
Participants voluntarily switched from a high-carbohydrate (>200 g/day; 55% of calories) and low-fat (20% of calories) diet to a low-carbohydrate (<50 g/day; 5% of calories) diet. high-fat (70% of calories), eucaloric diet. There was no difference in the proportion of calories from protein between diets (25%). The intervention lasted one year.
Evaluated study parameters
Study parameters included before (baseline) and after (1 year): hemoglobin A1CBody mass index (BMI), total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides, creatinine, liver enzymes (aspartate aminotransferase (AST) and alanine transaminase (ALT)) and Insulinemia.
Participants completed assessments of glucose and ketonemia levels at home before and after each meal and recorded the amount of insulin used. The researchers collected blood glucose data from the patients weekly.
Primary outcome
There was no prespecified primary outcome in this retrospective observational study. The authors stated: “Our goal is to evaluate glycemic control, the amount of insulin required to maintain glycemic control and the safety of EVLCD.”
Key findings
Glycemic control:
A1C: The percentage of patients with A1cValues below 7% were 12.1% at the start of the study and 57.6% after one year (P<0.01). Overall, 32/33 patients saw an improvement in glycemic control by lowering A1C.
Insulin consumption:
The average dosage of rapid-acting insulin decreased significantly from 18.3 IU (±9.5 IU) per day to 10.3 IU (±6.5 IU) per day (P<0.001). This dramatic reduction resulted in a statistically significant reduction in total insulin consumption from 36.7 IU (±14.9 IU) per day to 28.9 IU (±9.1 IU) per day (P<0.001).
Side effects:
At baseline, 54.5% of patients reported at least one episode of stage 2 hypoglycemia in the past year, and 30.3% reported a major hypoglycemia event in the past year. At study completion, 24.2% of patients reported a single episode of stage 2 hypoglycemia while maintaining EVLCD in the previous year (P<0.001).
transparency
This study was conducted in hospitals in Italy, at clinics run by lead author Kleiner. The authors declared that there is no conflict of interest.
Implications and limitations for practice
This was a fascinating study that showed that when T1DM patients switched from a high-carb to a low-carb diet, their diabetes was better controlled. Specifically, they had to use significantly less rapid-acting insulin—from an average of 18.3 IU to 10.3 IU—and their basal insulin remained the same; their LDL levels fell significantly (98.5 to 84.4 mg/dl;P=0.005); BMI was stable; and blood pressure was stable. There was a statistically significant decrease in episodes of severe hypoglycemia from before to after. No side effects or negative reactions occurred as a result of the study.
The study was small, but the results were good, statistically significant and encouraging. A further limitation was the voluntary change in diet, which was particularly motivated in adult patients. Clinical staff also closely monitored patients, and such close monitoring may have improved outcomes.
The diet itself was limited - vegetables, olive oil, fish, white meat, eggs, nuts, butter and cheese.
The diet itself was limited - vegetables, olive oil, fish, white meat, eggs, nuts, butter and cheese. Curiously, to provide more variety, the diet also included low-carb foods - bread, pasta, rice, rusks and sweets - all with a carbohydrate content of less than 5%. They have not provided any further information about these products to help us understand what they are made of to ensure a low-carb diet.
Personally, I am not surprised by this study as I have been using a low carbohydrate diet for all diabetics for 30 years, ever since I read Dr. Richard Bernstein read and gave lectures with him. Bernstein came up with the idea of using a low-carbohydrate diet for diabetics because he was a type 1 diabetic himself and this greatly improved his health and glucose control. It is good to see more studies demonstrating the logic, clarity, feasibility, safety and effectiveness of a low-carb diet for diabetics. One can only hope that one day in the future, conventional medicine will also have this enormously powerful light bulb.