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Low Carb Diet Can Improve Glycemic Control, Lipid Profile in Adolescents with Type 1 Diabetes

An RCT comparing a low carbohydrate diet against a Mediterranean diet in adolescents with T1D provides insight into the effects of both dietary approaches on glycemic control among these patients.

New research presented at the 15th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD) suggests adherence to a low carbohydrate diet, as opposed to a Mediterranean diet, could result in more favorable glycemic control and improved cardiometabolic health for adolescent patients with type 1 diabetes.

A 12-week randomized controlled trial comparing a low carbohydrate diet versus a Mediterranean diet in adolescent patients with type 1 diabetes, results of the study indicate adherence to a low carbohydrate diet was associated with significantly improved HbA1c and time-in-range (TIR) as well as improved triglyceride levels when compared to a Mediterranean diet.

“In this study of youth with type one diabetes, we saw the effect of a low carbohydrate diet versus Mediterranean diet upon glycemic control. Our data suggests that the low carbohydrate (diet) significantly improve all glycemic measures compared to the Mediterranean,” said study presenter Neriya Levran, RD, of the Pediatric Endocrinology and Diabetes Unit at the Sheba Medical Center in Israel, during the study presentation.

Citing the difficulty of matching carbohydrate intake with insulin dose in younger patients, Levran and a team of colleagues sought to explore the effects of different dietary approaches on different glycemic control metrics among adolescent patients with type 1 diabetes. With this in mind, investigators designed their study as a randomized, parallel assignment clinical trial with the aim of comparing the effects of a low carbohydrate diet against a Mediterranean diet on glycemic control and lipid profile.

“According to literature, the glycemic control of adolescents with type 1 diabetes is suboptimal with an increased risk of complications,” noted Levran.

Individuals for the trial were recruited from the Pediatric Endocrinology and Diabetes Unit of the Sheba Medical Center. To be considered eligible for the trial, patients needed to be between 12-21 years of age, have a duration of type 1 diabetes lasting at least 1 year, and being using a continuous glucose monitoring device. Patients deemed eligible for inclusion were randomized in a 1:1 ratio to either a low carbohydrate diet or to a Mediterranean diet, with each participant taking part in a cooking workshop and receiving a personalized diet plan at baseline. Outcomes of interest for the trial included change in time in range, HbA1c, lipid profile, BMI, and glucose variability from baseline to week 12.

Conducted between August 2019 and May 2020, the trial enrolled 24 individuals with 12 randomized to each arm. Investigators noted baseline characteristics were similar between the study arms. Before entering the trial, the mean carbohydrate intake was 147±28 grams per day in the low carbohydrate diet arm and 164±50 grams per day for the Mediterranean diet arm (P=.33). Upon completion of the 12-week intervention, the mean carbohydrate intake per day was 59±20 grams per day in the low carbohydrate diet arm and 152±55 grams per day for the Mediterranean diet arm.

Results of the investigators’ analyses suggested the TIR was 66±16% among those in the low carbohydrate arm and 55±16% in the Mediterranean diet arm (P=.04), but investigators pointed out there was no difference observed for percentage of time spent below 54 mg/dL, with rat3s of 1.6±1.9% and 2.4±2.3%, respectively.

Analysis of changes in HbA1c level from baseline to the end of the trial indicated adherence to a low carbohydrate was associated with a significant decrease in HbA1c levels, with the mean HbA1c among participants in the group decreasing from 8.3±1.3% to 7.2±0.9 (P=.006). Additionally, results suggested adherence to a low carbohydrate diet was associated with a greater degree of reduction in triglycerides than adherence to a Mediterranean diet (P=.39).

This study, “Low Carbohydrate Diet versus Mediterranean Diet in Adolescents with Type 1 Diabetes: A Randomized Control Trial,” was presented at ATTD 2022.