TY - JOUR
T1 - Low-carbohydrate diets in type 1 diabetes
T2 - balancing benefits and risks
AU - Hancock, Michael
AU - Burns, Kharis
AU - Gan, Seng Khee
AU - Chew, Gerard T.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - PURPOSE OF REVIEW: Interest in the use of calorie restriction with low-carbohydrate diets for patients with type 1 diabetes appears to be increasing despite physicians' discomfort about its longer term outcomes. A divergence in opinion regarding the balance of benefits and safety may lead to patient disengagement from conventional medical supervision. This review describes the current evidence regarding the benefits and risks of these diets and suggests a way forward to addressing this potential misalignment between the aims of patients and their physicians. RECENT FINDINGS: Benefits on glycaemia are observed in many studies, with improved HbA1c, time within target range and reduced glycaemic variability. A characteristic lipid profile with high LDL cholesterol is observed in many patients, but association with future cardiovascular events is undefined. A negative impact on growth has been identified in the paediatric population, and impact on mental health and disordered eating is of theoretical concern, without measurement in clinical studies. SUMMARY: Patients will continue to trial and, with immediate glycaemic benefits, potentially remain on lower carbohydrate diets irrespective of concern by treating physicians about potential longer term risks. A supportive multidisciplinary approach with greater nutritional supervision and more research is required, to allow these patients to achieve their desired glycaemic outcomes without compromising longer term safety.
AB - PURPOSE OF REVIEW: Interest in the use of calorie restriction with low-carbohydrate diets for patients with type 1 diabetes appears to be increasing despite physicians' discomfort about its longer term outcomes. A divergence in opinion regarding the balance of benefits and safety may lead to patient disengagement from conventional medical supervision. This review describes the current evidence regarding the benefits and risks of these diets and suggests a way forward to addressing this potential misalignment between the aims of patients and their physicians. RECENT FINDINGS: Benefits on glycaemia are observed in many studies, with improved HbA1c, time within target range and reduced glycaemic variability. A characteristic lipid profile with high LDL cholesterol is observed in many patients, but association with future cardiovascular events is undefined. A negative impact on growth has been identified in the paediatric population, and impact on mental health and disordered eating is of theoretical concern, without measurement in clinical studies. SUMMARY: Patients will continue to trial and, with immediate glycaemic benefits, potentially remain on lower carbohydrate diets irrespective of concern by treating physicians about potential longer term risks. A supportive multidisciplinary approach with greater nutritional supervision and more research is required, to allow these patients to achieve their desired glycaemic outcomes without compromising longer term safety.
UR - http://www.scopus.com/inward/record.url?scp=85148678608&partnerID=8YFLogxK
U2 - 10.1097/MED.0000000000000797
DO - 10.1097/MED.0000000000000797
M3 - Review article
C2 - 36668976
AN - SCOPUS:85148678608
SN - 1752-296X
VL - 30
SP - 113
EP - 122
JO - Current opinion in endocrinology, diabetes, and obesity
JF - Current opinion in endocrinology, diabetes, and obesity
IS - 2
ER -