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Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study
Vit Neuman1, Lukas Plachy1, Stepanka Pruhova1
1Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, CZ-15006 Prague, Czech Republic.
Insights
Low carbohydrate diet (LCD) is common in children with type 1 diabetes (T1D), showing improved glycemic control. However, this dietary approach may increase the risk of hypoglycemia, requiring careful monitoring.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Type 1 diabetes (T1D) management in children requires careful consideration of dietary approaches.
- The prevalence and impact of low-carbohydrate diets (LCDs) among pediatric T1D populations remain largely uncharacterized.
Purpose of the Study:
- To determine the frequency of LCD use in children with T1D.
- To analyze the clinical and laboratory characteristics of children with T1D on an LCD compared to those not on an LCD.
Main Methods:
- A structured questionnaire was administered to caregivers of 1040 children with T1D across three treatment centers.
- Participants on an LCD (carbohydrate intake <26% of age-recommended values) were compared to age-, sex-, and treatment-matched controls.
Main Results:
- Of 624 respondents, 39% reported experience with carbohydrate restriction, and 5.8% were currently on an LCD.
- The LCD group exhibited similar HbA1c levels but showed lower average glycemia, higher time in range, and lower time in hyperglycemia.
- The LCD group also had a tendency towards more hypoglycemia and lower systolic blood pressure percentile; lipid profiles and BMI were comparable.
Conclusions:
- Low carbohydrate diet is a prevalent dietary strategy among children with T1D.
- LCDs are associated with improved glycemic control markers but carry a potential risk of increased hypoglycemia.
- Parental or patient initiation of LCDs was common, with suboptimal consultation rates with diabetologists.
Aims/Hypothesis:
The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data.
Methods:
Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children's carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment.
Results:
A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist.
Conclusions/Interpretation:
Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.
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