Current controversies surrounding low-carbohydrate diets in children with type 1 diabetes

The carbohydrate-restricted diets are becoming increasingly popular among the general public, as well as among obese and insulin-resistant individuals, and patients with both type 2 and type 1 diabetes (T1D), including children and adolescents. Nevertheless, the scientific evidence supporting the effectiveness of these diets in T1D is limited. While current general guidelines for childhood nutrition recommend a moderate carbohydrate intake of about 45% of daily calorie requirements, there is no research to establish a single optimal amount of carbohydrate in the diet of people with diabetes. The main reasons for patients to restrict carbohydrates in their diet are the potential to reduce postprandial glycemia variability, improve metabolic control, and reduce the risk of weight gain due to lower insulin doses. On the other hand, the greatest concerns of physicians are the potential to induce dyslipidemia, hypoglycemia, eating disorders, disruption of normal childhood development, or the transition of ketonemia caused by a low-carbohydrate diet (LCD) to diabetic ketoacidosis. We aimed to summarize the latest findings on low-carbohydrate diets, the potential consequences of their use, as well as their suggested benefits and impact on glycemic control in youths with type 1 diabetes.