ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism
REVIEW

Low-Carbohydrate Diets and Type 1 Diabetes
Düşük Karbonhidratlı Diyetler ve Tip 1 Diyabet
Doi: 10.25179/tjem.2019-65625 - Makale Dili: EN
Turk J Endocrinol Metab 2019;23:112-121
ABSTRACT
Despite the significant medical and technological advances, the management of Type 1 diabetes remains unsatisfactory. The most significant challenge herein is the difficulty in controlling post-prandial glycemia. The type and amount of carbohydrates consumed have a greater influence on the post-prandial hyperglycemia and glycemic variability than other dietary factors, which consequently generates interest in carbohydrate-modified diets for the management of Type 1 diabetes. Individuals with Type 1 and Type 2 diabetes prefer low-carbohydrate diet regimens in order to maintain glycemic control. Few studies have examined the effects of a low-carbohydrate diets on the course of glycemic control in individuals with Type 1 diabetes. Low-carbohydrate diets may reduce glycemic fluctuation, hemoglobin A1c levels, and insulin requirement in adults with Type 1 diabetes. The long-term effects of a low-carbohydrate diets are not well documented, although it is believed to alter the lipid profile and cause nutrient deficiencies and cardiac complications in the long term. In children and adolescents with Type 1 diabetes, it may improve glucose levels in the short term, although it may lead to growth retardation, deficiency in the intake of vitamin, minerals, and fiber, increase in blood lipids, fatigue, anxiety, and social isolation. This review discusses the effects of low-carbohydrate diets on Type 1 diabetes.
ÖZET
Önemli medikal ve teknolojik ilerlemelere rağmen Tip 1 yönetimi yetersiz kalmaktadır. Bu konudaki en önemli zorluk postprandiyal glisemiyi kontrol etmedeki güçlüktür. Tüketilen karbonhidratın türü ve miktarı postprandiyal hipeglisemiyi ve glisemik değişkenliği diğer diyetsel faktörlerden daha fazla etkilemekte, bu durum da Tip 1 diyabette karbonhidratı modifiye edilmiş diyetlere ilgiyi artırmaktadır. Tip 1 ve tip 2 diyabetli bireyler, glisemik kontrollerini sağlamak için düşük karbonhidratlı diyet uygulamalarını tercih etmektedir. Düşük karbonhidratlı diyetlerin tip 1 diyabetli bireylerde glisemik seyir üzerine etkisini inceleyen sınırlı sayıda çalışma bulunmaktadır. Erişkin Tip 1 diyabetli bireylerde düşük karbonhidratlı diyetler glisemik dalgalanmayı, hemoglobin A1c seviyelerini ve insülin ihtiyacını azaltabilmektedir. Düşük karbonhidratlı diyetin uzun dönem etkileri tam olarak kanıtlanamamakla birlikte, uzun dönemde lipit profilinde değişikliğe, besin ögesi yetersizliği ve kardiyak komplikasyonlara neden olabilmektedir. Tip 1 diyabetli çocuk ve adolesanlarda kısa dönemde glukoz seviyelerini iyileştirebilmekte, ancak uzun dönemde büyüme geriliğine, vitamin-mineral ve posa alımında yetersizliğe, kan lipitlerinde artışa, yorgunluk, anksiyete ve sosyal izolasyona yol açabilmektedir. Bu çalışmada, düşük karbonhidratlı diyetlerin Tip 1 diyabet üzerindeki etkilerinin tartışılması amaçlanmıştır.
KAYNAKLAR
  1. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41:S13S27. [Crossref] [PubMed]
  2. Alemzadeh R, Wyatt D. Diabetes mellitus. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17 th ed. Philadelphia: Saunders; 2004. p.1947-1972.
  3. Unger RH, Foster DW, Wilson JD, Foster DW, Kronenberg HM, Larsen PR. Diabetes mellitus. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Textbook of Endocrinology. 16th ed. Philadelphia: WB Saunders Company 1998. p.973-1059.
  4. International Diabetes Federation. IDF Diabetes Atlas 2017 (8th ed). 2017:145.
  5. Nylander C, Tindberg Y, Haas J, Swenne I, Torbjörnsdotter T, Åkesson K, Örtqvist E, Gustafsson J, Fernell E. Self ‐and parent‐ reported executive problems in adolescents with type 1 diabetes are associated with poor metabolic control and low physical activity. Pediatric Diabetes. 2017;19:98-105. [Crossref] [PubMed]
  6. Abacı A, Böber E, Büyükgebiz A. Tip 1 diyabet. Güncel Pediatri. 2007;5:1-10.
  7. Pinhas-Hamiel O, Hamiel U, Boyko V, Graph-Barel C, Reichman B, Lerner-Geva L. Trajectories of HbA1c levels in children and youth with type 1 diabetes. PLoS One. 2014;9:e109109. [Crossref] [PubMed] [PMC]
  8. Brown A, Reynolds LR, Bruemmer D. Intensive glycemic control and cardiovascular disease: an update. Nat Rev Cardiol. 2010;7:369-375. [Crossref] [PubMed]
  9. DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes. 2018;19:105-114. [Crossref] [PubMed]
  10. Gesuita R, Skrami E, Bonfanti R, Cipriano P, Ferrito L, Frongia P, Lafusco D, Iannilli A, Lombardo F, Mozzillo E, Paleari R, Rabbone I, Sabbion A, Salvatoni A, Scaramuzza A, Schiaffini R, Sulli N, Toni S, Carle F, Cherubini V. The role of socio-economic and clinical factors on HbA1c in children and adolescents with type 1 diabetes: an Italian multicentre survey. Pediatr Diabetes. 2017;18:241-248. [Crossref] [PubMed]
  11. Wood JR, Miller KM, Maahs DM, Beck RW, DiMeglio LA, Libman IM, Quinn M, Tamborlane WV, Woerner SE. Most youth with type 1 diabetes in the T1D exchange clinic registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes Care. 2013;36:2035-2037. [Crossref] [PubMed] [PMC]
  12. McKnight JA, Wild SH, Lamb MJ, Cooper MN, Jones TW, Davis EA, Hofer S, Fritsch M, Schober E, Svensson J, Almdal T, Young R, Warner JT, Delemer B, Souchon PF, Holl RW, Karges W, Kieninger DM, Tigas S, Bargiota A, Sampanis C, Cherubini V, Gesuita R, Strele I, Pildava S, Coppell KJ, Magee G, Cooper JG, Dinneen SF, Eeg-Olofsson K, Svensson AM, Gudbjornsdottir S, Veeze H, Aanstoot HJ, Khalangot M, Tamborlane WV, Miller KM. Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med. 2015;32:1036-1050. [Crossref] [PubMed]
  13. Petitti DB, Klingensmith GJ, Bell RA, Andrews JS, Dabelea D, Imperatore G, Marcovina S, Pihoker C, Standiford D, Waitzfelder B, Mayer-Davis E. Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study. J Pediatr. 2009;155:668672.e1-3. [Crossref] [PubMed] [PMC]
  14. Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:14641476. [Crossref] [PubMed]
  15. Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL; Diabetes Canada Clinical Practice Guidelines Expert Committee. Nutrition therapy. Can J Diabetes. 2018;42:64-79. [Crossref] [PubMed]
  16. Nielsen JV, Gando C, Joensson E, Paulsson C. Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: a clinical audit. Diabetol Metab Syndr. 2012;4:23. [Crossref] [PubMed] [PMC]
  17. Turton JL, Raab R, Rooney KB. Low-carbohydrate diets for type 1 diabetes mellitus: a systematic review. PloS One. 2018;13:e0194987. [Crossref] [PubMed] [PMC]
  18. de Bock M, Lobley K, Anderson D, Davis E, Donaghue K, Pappas M, Siafarikas A, Cho YH, Jones T, Smart C. Endocrine and metabolic consequences due to restrictive carbohydrate diets in children with type 1 diabetes: an illustrative case series. Pediatr Diabetes. 2018;19:129-137. [Crossref] [PubMed]
  19. Gumbiner B, Wendel JA, McDermott MP. Effects of diet composition and ketosis on glycemia during very-low-energy-diet therapy in obese patients with non-insulin-dependent diabetes mellitus. Am J Clin Nutr. 1996;63:110-115. [Crossref] [PubMed]
  20. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS Jr, Brehm BJ, Bucher HC. Effects of low carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166:285-293. [Crossref] [PubMed]
  21. Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc. 2008;108:91-100. [Crossref] [PubMed]
  22. Nuttal FQ, Gannon MC. The metabolic response to a high-protein, low carbohydrate diet in men with type 2 diabetes mellitus. Metabolism. 2006;55:243251. [Crossref] [PubMed]
  23. Nielsen JV, Jönsson E, Ivarsson A. A low carbohydrate diet in type 1 diabetes: clinical experience--a brief report. Ups J Med Sci. 2005;110:267-273. [Crossref] [PubMed]
  24. Ranjan A, Schmidt S, Damm-Frydenberg C, Holst JJ, Madsbad S, Nørgaard K. Short-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: a randomized open-label crossover trial. Diabetes Obes Metab. 2017;19:1479-1484. [Crossref] [PubMed]
  25. Diamond M, Clark EJ. Low-carbohydrate diets and glycaemic control in type 1 diabetes mellitus. EMJ Diabet. 2018;6:70-77.
  26. Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-lowcarbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med. 2018;35:1258-1263. [Crossref] [PubMed]
  27. Bilsborough SA, Crowe TC. Low-carbohydrate diets: what are the potential short-and long-term health implications? Asia Pac J Clin Nutr. 2003;12:396-404
  28. Dzygalo K, Szypowska A. Impact of insulins glulisine and aspart on postprandial glycemia after a high-glycemic index meal in children with type 1 diabetes. Eur J Endocrinol. 2014;170:539-545. [Crossref] [PubMed]
  29. Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS Jr. Macronutrients, food groups, and eating patterns in the management of diabetes a systematic review of the literature, 2010. Diabetes Care. 2012;35:434-445. [Crossref] [PubMed] [PMC]
  30. Krebs JD, Parry Strong A, Cresswell P, Reynolds AN, Hanna A, Haesusler S. A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes dy weight into account. Asia Pac J Clin Nutr. 2016;25:78-84.
  31. Waldron S. Controversies in the dietary management of diabetes in childhood and adolescence. Br J Hosp Med. 1996;56:450-454.
  32. Heinemann L. Variability of insulin absorption and insulin action. Diabetes Technol Ther. 2002;4:673682. [Crossref] [PubMed]
  33. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31:1-13. [Crossref] [PubMed]
  34. O’Neill DF, Westman EC, Bernstein RK. The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus. Metab Syndr Relat Disord. 2003;1:291-298. [Crossref] [PubMed]
  35. Eiswirth M, Clark E, Diamond M. Low carbohydrate diet and improved glycaemic control in a patient with type one diabetes. Endocrinol Diabetes Metab Case Rep. 2018;2018:1. [Crossref] [PubMed] [PMC]
  36. Buyken AE, Toeller M, Heitkamp G, Irsigler K, Holler C, Santeusanio F, Stehle P, Fuller JH. Carbohydrate sources and glycaemic control in type 1 diabetes mellitus. EURODIAB IDDM Complications Study Group. Diabet Med. 2000;17:351-359. [Crossref] [PubMed]
  37. Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS, Ludwig DS. Management of type 1 diabetes with a very low-carbohydrate diet. Pediatrics. 2018;141:e20173349. [Crossref] [PubMed] [PMC]
  38. Mayer-Davis EJ, Laffel LM, Buse JB. Management of type 1 diabetes with a very low-carbohydrate diet: a word of caution. Pediatrics. 2018;142:e20181536B. [Crossref] [PubMed] [PMC]
  39. Dressler A, Reithofer E, Trimmel-Schwahofer P, Klebermasz K, Prayer D, Kasprian G, Rami B, Schober E, Feucht M. Type 1 diabetes and epilepsy: efficacy and safety of the ketogenic diet. Epilepsia. 2010;51:1086-1089. [Crossref] [PubMed]
  40. Aguirre Castaneda RL, Mack KJ, Lteif A. Successful treatment of type 1 diabetes and seizures with combined ketogenic diet and insulin. Pediatrics. 2012; 129:e511-514. [Crossref] [PubMed]
  41. Bernstein RK. Dr. Bernstein’s Diabetes Solution: the Complete Guide to Achieving Normal Blood Sugars (4th ed). New York: Little, Brown and Co; 2011;560.
  42. Tóth C, Clemens Z. Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. Int J Case Rep Images. 2014;5:699-703. [Crossref]
  43. Tóth C, Clemens Z. A child with type 1 diabetes mellitus (T1DM) successfully treated with the paleolithic ketogenic diet: a 19-month insulin freedom. Int J Case Rep Images. 2015;6:752-757. [Crossref]
  44. Delahanty LM, Nathan DM, Lachin JM, Hu FB, Cleary PA, Ziegler GK, Wylie-Rosett J, Wexler DJ. Associa-tion of diet with glycated hemoglobin during inten-sive treatment of Type 1 diabetes in the Diabetes Control and Complications Trial. Am J Clin Nutr. 2009;89:518-524. [Crossref] [PubMed] [PMC]