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- Title
The ups and downs of low‐carbohydrate diets in the management of Type 1 diabetes: a review of clinical outcomes.
- Authors
Seckold, R.; Fisher, E.; Bock, M.; King, B. R.; Smart, C. E.
- Abstract
Dietary management has been a mainstay of care in Type 1 diabetes since before the discovery of insulin when severe carbohydrate restriction was advocated. The use of insulin facilitated re‐introduction of carbohydrate into the diet. Current management guidelines focus on a healthy and varied diet with consideration of glycaemic load, protein and fat. As a result of frustration with glycaemic outcomes, low‐carbohydrate diets have seen a resurgence in popularity. To date, low‐carbohydrate diets have not been well studied in the management of Type 1 diabetes. Studies looking at glycaemic outcomes from low‐carbohydrate diets have largely been cross‐sectional, without validated dietary data and with a lack of control groups. The participants have been highly motivated self‐selected individuals who follow intensive insulin management practices, including frequent blood glucose monitoring and additional insulin corrections with tight glycaemic targets. These confounders limit the ability to determine the extent of the impact of dietary carbohydrate restriction on glycaemic outcomes. Carbohydrate‐containing foods including grains, fruit and milk are important sources of nutrients. Hence, low‐carbohydrate diets require attention to vitamin and energy intake to avoid micronutrient deficiencies and growth issues. Adherence to restricted diets is challenging and can have an impact on social normalcy. In individuals with Type 1 diabetes, adverse health risks such as diabetic ketoacidosis, hypoglycaemia, dyslipidaemia and glycogen depletion remain clinical concerns. In the present paper, we review studies published to date and provide clinical recommendations for ongoing monitoring and support for individuals who choose to adopt a low‐carbohydrate diet. Strategies to optimize postprandial glycaemia without carbohydrate restriction are presented. What's new?: Low‐carbohydrate diets are of interest for improving glycaemic outcomes in the management of Type 1 diabetes. There is limited evidence to support their routine use in the management of Type 1 diabetes.Existing studies are mainly in self‐selected individuals who practise diligent intensive insulin management, coupled with carbohydrate restriction. Adherence appears challenging and there is a lack of validated dietary data.The possible benefits of carbohydrate restriction on glycaemia in Type 1 diabetes management should be weighed against the clinical concerns and potential adverse health outcomes.Open dialogue is necessary to keep families and individuals engaged with the healthcare team.Individuals with Type 1 diabetes should be counselled on strategies with which to optimize postprandial glycaemia whilst eating a variety of nutritious foods.
- Subjects
ATTENTION; BLOOD sugar monitoring; DIET therapy; CARBOHYDRATE content of food; FAT content of food; FRUIT; GLYCEMIC index; GRAIN; HYPOGLYCEMIA; INGESTION; INSULIN; TYPE 1 diabetes; LOW-carbohydrate diet; MEDICAL protocols; MILK; NUTRITIONAL requirements; DIETARY proteins; MICRONUTRIENTS
- Publication
Diabetic Medicine, 2019, Vol 36, Issue 3, p326
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/dme.13845