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A reduced carbohydrate approach to managing type 1 diabetes

This month, a reduced carbohydrate approach to managing type 1 diabetes took the spotlight in a paper published in the journal Pediatrics and led by researchers from Harvard. The paper was circulated widely by the media and featured in the New York Times, the article becoming the newspaper’s most-shared article of the week. Entitled ‘Management of Type 1 Diabetes with a Very Low-Carbohydrate Diet’, the study took data from 316 participants from around the world, 131 of whom were children, who follow a very low carbohydrate diet to manage their type 1 diabetes. The average length of time following the diet was 2.2 years and the average carbohydrate intake was 36 grams per day. Data was collected via an online survey, and confirmed by the participant’s diabetes care team and medical records where possible. Some interesting observations for you, with some comments and comparative statistics from Australia for reference: Average HbA1c: 5.67%. The average HbA1c of WA children with type 1 is 8.2%. Percentage of participants who met the target HbA1c range: 97%. The percentage of children achieving target HbA1c (<7.5%) in WA is 36%. Time spent in range: The average blood glucose reported by 137 participants wearing CGM was 5.8mmol/L, with an average standard deviation of 1.5mmol/L. This means that participants spent the majority of time with blood glucose levels in the range of 4.3-7.3mmol/L (comparative data for WA patients not available). Hypo rates: Of those participants reporting on hypoglycaemia, 68% reported five or fewer hypoglycaemic events per month (comparative data for WA patients not available). Diabetic Ketoacidosis: 1.2% of participants (note - adults and children) reported a hospital admission for DKA in the previous 12 months. Australian data shows that approximately 5% of children and young people with type 1 diabetes were hospitalised for DKA between 2014-15. Cholesterol: Overall, cholesterol was elevated compared with reference ranges. Importantly, the 27-year follow-up of 1236 participants in the Diabetes Control and Complications Trial, found that elevated HbA1c was a greater risk factor for cardiovascular disease than blood lipids. Growth: Height was assessed as an indicator for growth, and the heights of children in the study were found to be modestly above average. There was a marginal decrease in growth in height post-diagnosis, however, it was comparable to the decrease in growth in type 1 children not following a low-carb diet which is described in other research. The researchers concluded ‘these data do not reveal an adverse effect of a Very Low Carbohydrate Diet on growth’ but they also suggested that this is an area for further research. Overview: This study is exciting and provides a foundation for the potential therapeutic uses of a reduced carbohydrate approach to diabetes management, and it is promising that the authors have recommended more research into this area. More and more clinicians and consumers recognise the value and applications of this approach; indeed, this month I am speaking at the Dietitians Association of Australia National Conference about using a reduced carbohydrate approach in clinical practice. As a clinician, I help my patients meet their goals by helping work out their nutrition needs and how to meet their targets each day. I encourage you to seek the advice of a professional with a patient-centred approach, who is willing to support your choices and help you to implement them safely and effectively.

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