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Neuman V, Plachy L, Drnkova L, Pruhova S, Kolouskova S, Obermannova B, Amaratunga SA, Maratova K, Kulich M, Havlik J, Funda DP, Cinek O, Sumnik Z. Low-carbohydrate diet in children and young people with type 1 diabetes: A randomized controlled trial with cross-over design. Diabetes Res Clin Pract 2024; 217:111844. [PMID: 39237039 DOI: 10.1016/j.diabres.2024.111844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/26/2024] [Accepted: 09/01/2024] [Indexed: 09/07/2024]
Abstract
AIMS We investigated whether a short period of tightly controlled low-carbohydrate diet (LCD) leads to higher time in range without increasing the associated risks in children and young people with diabetes (CYPwD). METHODS Thirty-five (CYPwD) were recruited into this randomized controlled cross-over study (20 female; 20 CSII; age 14.5 ± 2.9 years; HbA1c 48.9 ± 9.4 mmol/mol). The interventions were five and five weeks of ready-made food box deliveries of isocaloric diets in random order: either LCD (94.5 ± 4.7 g/day) or recommended carbohydrate diet (RCD) (191 ± 19.2 g/day). The outcomes were continuous glucose monitoring parameters, anthropometric, laboratory and quality of life (QoL) data. RESULTS Time in range was significantly higher in the LCD than in the RCD period (77.1 % vs. 73.8 %, P=0.008). Times in hyperglycemia and average glycaemia were significantly lower in the LCD. There was no difference between the diets in time in hypoglycemia or glycemic variability. The subjects' body weight and BMI were significantly lower during the LCD. There was no significant difference in the LDL-cholesterol levels. No significant differences were observed in the self-assessed QoL. CONCLUSIONS Short-term LCD led to an improvement of glycemic parameters without increasing time in hypoglycemia, disturbing the lipid profile or negatively affecting the quality of life of CYPwD.
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Affiliation(s)
- V Neuman
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic.
| | - L Plachy
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - L Drnkova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - S Pruhova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - S Kolouskova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - B Obermannova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - S A Amaratunga
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - K Maratova
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
| | - M Kulich
- Charles University in Prague, Faculty of Mathematics and Physics, Department of Probability and Mathematical Statistics, Prague, Czechia, Czech Republic
| | - J Havlik
- Department of Food Science, Czech University of Life Sciences, Prague, Czechia, Czech Republic
| | - D P Funda
- Institute of Microbiology of the Czech Academy of Sciences, v.v.i., Prague, Czechia, Czech Republic
| | - O Cinek
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic; Department of Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic; Czech Institute of Virology, Prague, Czechia, Czech Republic
| | - Z Sumnik
- Department of Pediatrics, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia, Czech Republic
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2
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Irandoust K, Parsakia K, Estifa A, Zoormand G, Knechtle B, Rosemann T, Weiss K, Taheri M. Predicting and comparing the long-term impact of lifestyle interventions on individuals with eating disorders in active population: a machine learning evaluation. Front Nutr 2024; 11:1390751. [PMID: 39171102 PMCID: PMC11337873 DOI: 10.3389/fnut.2024.1390751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Objective This study aims to evaluate and predict the long-term effectiveness of five lifestyle interventions for individuals with eating disorders using machine learning techniques. Methods This study, conducted at Dr. Irandoust's Health Center at Qazvin from August 2021 to August 2023, aimed to evaluate the effects of five lifestyle interventions on individuals with eating disorders, initially diagnosed using The Eating Disorder Diagnostic Scale (EDDS). The interventions were: (1) Counseling, exercise, and dietary regime, (2) Aerobic exercises with dietary regime, (3) Walking and dietary regime, (4) Exercise with a flexible diet, and (5) Exercises through online programs and applications. Out of 955 enrolled participants, 706 completed the study, which measured Body Fat Percentage (BFP), Waist-Hip Ratio (WHR), Fasting Blood Sugar (FBS), Low-Density Lipoprotein (LDL) Cholesterol, Total Cholesterol (CHO), Weight, and Triglycerides (TG) at baseline, during, and at the end of the intervention. Random Forest and Gradient Boosting Regressors, following feature engineering, were used to analyze the data, focusing on the interventions' long-term effectiveness on health outcomes related to eating disorders. Results Feature engineering with Random Forest and Gradient Boosting Regressors, respectively, reached an accuracy of 85 and 89%, then 89 and 90% after dataset balancing. The interventions were ranked based on predicted effectiveness: counseling with exercise and dietary regime, aerobic exercises with dietary regime, walking with dietary regime, exercise with a flexible diet, and exercises through online programs. Conclusion The results show that Machine Learning (ML) models effectively predicted the long-term effectiveness of lifestyle interventions. The current study suggests a significant potential for tailored health strategies. This emphasizes the most effective interventions for individuals with eating disorders. According to the results, it can also be suggested to expand demographics and geographic locations of participants, longer study duration, exploring advanced machine learning techniques, and including psychological and social adherence factors. Ultimately, these results can guide healthcare providers and policymakers in creating targeted lifestyle intervention strategies, emphasizing personalized health plans, and leveraging machine learning for predictive healthcare solutions.
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Affiliation(s)
- Khadijeh Irandoust
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Kamdin Parsakia
- Department of Psychology and Counseling, KMAN Research Institute, Richmond Hill, ON, Canada
| | - Ali Estifa
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Gholamreza Zoormand
- Department of Physical Education, Huanggang Normal University, Huanggang, China
| | - Beat Knechtle
- Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zürich, Zürich, Switzerland
| | - Katja Weiss
- Institute of Primary Care, University of Zürich, Zürich, Switzerland
| | - Morteza Taheri
- Department of Cognitive and Behavioural Sciences in Sport, Faculty of Sport Science and Health, University of Tehran, Tehran, Iran
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Chad-Friedman E, Clary L, Jhe G. Disordered eating in adolescents with type 1 diabetes: risk factors and screening recommendations. Curr Opin Pediatr 2024; 36:351-357. [PMID: 38655800 DOI: 10.1097/mop.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Adolescents with Type 1 diabetes (T1D) are at significantly greater risk for disordered eating behaviors compared to their peers without T1D. Given that this is a dangerous and potentially lethal combination, this review aims to support pediatric medical providers in increasing competence in identification, assessment, and prevention of disordered eating behaviors in adolescents with T1D. RECENT FINDINGS This review provides an up-to-date synthesis of unique risk factors for disordered eating behaviors in adolescents with T1D, including the daily diabetes management tasks, effects of insulin on weight and hunger, family conflict, and reinforcement from their environment for disordered behaviors. This review recommends two brief screening tools, the Diabetes Eating Problems Survey-Revised (DEPS-R) and Modified SCOFF (mSCOFF), to be used in busy practices; it also provides practical strategies for providersto use with patients in the form of effective, nonjudgmental language. SUMMARY A clear understanding of unique experiences impacting adolescents with T1D may increase use of evidence-based screening tools and identification of disordered eating behaviors among a high-risk population in clinic/practice. In addition, providers' intentional use of nonjudgmental and de-stigmatizing language may lead to more positive interactions for adolescents and willingness to engage in further treatment.
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Affiliation(s)
- Emma Chad-Friedman
- Adolescent and Young Adult Medicine
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital
| | - Lauren Clary
- Children's National Hospital
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Grace Jhe
- Adolescent and Young Adult Medicine
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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4
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Martin R, Davis A, Pigott A, Cremona A. A scoping review exploring the role of the dietitian in the identification and management of eating disorders and disordered eating in adolescents and adults with type 1 diabetes mellitus. Clin Nutr ESPEN 2023; 58:375-387. [PMID: 38057030 DOI: 10.1016/j.clnesp.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Eating disorder diagnoses and disordered eating behaviours are more prevalent in people living with Type 1 Diabetes Mellitus, in particular in adolescents. The role of the dietitian in this setting is not clearly outlined in the literature. AIM This scoping review aims to outline the available information for the role of the dietitian in identifying and managing eating disorders in adolescents and adults with co-occurring Type 1 Diabetes Mellitus (T1DM) in a clinical setting. METHODS The Johanna Briggs Institute was utilised to guide this scoping review and to develop a search strategy for relevant databases. Relevant organisations and societies websites and professional magazines were reviewed as part of the grey literature search. RESULTS 38 peer reviewed journal articles, 5 professional articles, 5 book chapters and 11 clinical guidelines were included in this scoping review. Roles for the dietitian in identification, prevention and screening for eating disorders in Type 1 Diabetes Mellitus were identified and outlined in a visual workflow. The role of the dietitian in the management of eating disorder in both the outpatient/community and inpatient setting and as core member of the multidisciplinary team was detailed in the literature. CONCLUSION This scoping review mapped the available information in the current literature on the role of the dietitian in the identification and management of eating disorders and disordered eating in adolescents and adults with a dual diagnosis of T1DM. The reviewed literature suggests there is a strong reliance on expert opinion and practice to inform the role of the dietitian. Further research is required in order to ensure more robust evidence-based practice in this area.
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Affiliation(s)
- Ruth Martin
- Children's Health Ireland, Dublin, Ireland; Institute of Nutrition & Dietetics (INDI), Dublin, Ireland; University of Limerick, School of Allied Health, Limerick, Ireland
| | - Amanda Davis
- Metro North Hospital and Health Service, Queensland Eating Disorder Service, Brisbane, Australia
| | - Aisling Pigott
- Cardiff and Vale University Health Board, Cardiff, United Kingdom; Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Alexandra Cremona
- Institute of Nutrition & Dietetics (INDI), Dublin, Ireland; University of Limerick, School of Allied Health, Limerick, Ireland; Health Research Institute (HRI), University of Limerick, Limerick, Ireland.
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Neyman A, Hannon TS. Low-Carbohydrate Diets in Children and Adolescents With or at Risk for Diabetes. Pediatrics 2023; 152:e2023063755. [PMID: 37718964 DOI: 10.1542/peds.2023-063755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/19/2023] Open
Abstract
Carbohydrate restriction is increasingly popular as a weight loss strategy and for achieving better glycemic control in people with diabetes, including type 1 and type 2 diabetes. However, evidence to support low-carbohydrate diets in youth (children and adolescents 2-18 years of age) with obesity or diabetes is limited. There are no guidelines for restricting dietary carbohydrate consumption to reduce risk for diabetes or improve diabetes outcomes in youth. Thus, there is a need to provide practical recommendations for pediatricians regarding the use of low-carbohydrate diets in patients who elect to follow these diets, including those with type 1 diabetes and for patients with obesity, prediabetes, and type 2 diabetes. This clinical report will: Provide background on current dietary patterns in youth, describe how moderate-, low-, and very low-carbohydrate diets differ, and review safety concerns associated with the use of these dietary patternsReview the physiologic rationale for carbohydrate reduction in youth with type 1 diabetes and for youth with obesity, prediabetes, and type 2 diabetesReview the evidence for low-carbohydrate diets in the management of youth with type 1 diabetesReview the evidence for low-carbohydrate diets in the management of youth with obesity, prediabetes, and type 2 diabetesProvide practical information for pediatricians counseling families and youth on carbohydrate recommendations for type 1 diabetes and for obesity, prediabetes, and type 2 diabetes.
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Affiliation(s)
- Anna Neyman
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana
| | - Tamara S Hannon
- Indiana University School of Medicine, Riley Children's Hospital, Indianapolis, Indiana
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Turton JL, Brinkworth GD, Parker HM, Lim D, Lee K, Rush A, Johnson R, Rooney KB. Effects of a low-carbohydrate diet in adults with type 1 diabetes management: A single arm non-randomised clinical trial. PLoS One 2023; 18:e0288440. [PMID: 37432920 DOI: 10.1371/journal.pone.0288440] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
Public interest in low-carbohydrate (LC) diets for type 1 diabetes (T1D) management has increased. This study compared the effects of a healthcare professional delivered LC diet compared to habitual diets higher in carbohydrates on clinical outcomes in adults with T1D. Twenty adults (18-70 yrs) with T1D (≥6 months duration) with suboptimal glycaemic control (HbA1c>7.0% or >53 mmol/mol) participated in a 16-week single arm within-participant, controlled intervention study involving a 4-week control period following their habitual diets (>150 g/day of carbohydrates) and a 12-week intervention period following a LC diet (25-75 g/day of carbohydrates) delivered remotely by a registered dietitian. Glycated haemoglobin (HbA1c -primary outcome), time in range (blood glucose: 3.5-10.0 mmol/L), frequency of hypoglycaemia (<3.5 mmol/L), total daily insulin, and quality of life were assessed before and after the control and intervention periods. Sixteen participants completed the study. During the intervention period, there were reductions in total dietary carbohydrate intake (214 to 63 g/day; P<0.001), HbA1c (7.7 to 7.1% or 61 to 54 mmol/mol; P = 0.003) and total daily insulin use (65 to 49 U/day; P<0.001), increased time spent in range (59 to 74%; P<0.001), and improved quality of life (P = 0.015), with no significant changes observed during the control period. Frequency of hypoglycaemia episodes did not differ across timepoints, and no episodes of ketoacidosis or other adverse events were reported during the intervention period. These preliminary findings suggest that a professionally supported LC diet may lead to improvements in markers of blood glucose control and quality of life with reduced exogenous insulin requirements and no evidence of increased hypoglycaemia or ketoacidosis risk in adults with T1D. Given the potential benefits of this intervention, larger, longer-term randomised controlled trials are warranted to confirm these findings. Trial Registration: https://www.anzctr.org.au/ACTRN12621000764831.aspx.
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Affiliation(s)
- Jessica L Turton
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Helen M Parker
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - David Lim
- Church Street Medical Practice, Newtown, New South Wales, Australia
| | - Kevin Lee
- Qscan Group, Clayfield, Queensland, Australia
| | - Amy Rush
- Type 1 Diabetes Family Centre, Stirling, Western Australia, Australia
| | - Rebecca Johnson
- Type 1 Diabetes Family Centre, Stirling, Western Australia, Australia
| | - Kieron B Rooney
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Kietsiriroje N, Shah H, Zare M, O'Mahoney LL, West DJ, Pearson SM, Ajjan RA, Campbell MD. Dietary fat intake is associated with insulin resistance and an adverse vascular profile in patients with T1D: a pooled analysis. Eur J Nutr 2023; 62:1231-1238. [PMID: 36495341 PMCID: PMC10030402 DOI: 10.1007/s00394-022-03070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Insulin resistance (IR) increases vascular risk in individuals with Type 1 Diabetes (T1D). We aimed to investigate the relationship between dietary intake and IR, as well as vascular biomarkers in T1D. METHODS Baseline data from three randomised controlled trials were pooled. Estimated glucose disposal rate (eGDR) was used as an IR marker. Employing multivariate nutrient density substitution models, we examined the association between macronutrient composition and IR/vascular biomarkers (tumour necrosis factor-α, fibrinogen, tissue factor activity, and plasminogen activator inhibitor-1). RESULTS Of the 107 patients, 50.5% were male with mean age of 29 ± 6 years. Those with lower eGDR were older with a longer diabetes duration, higher insulin requirements, and an adverse vascular profile (p < 0.05). Patients with higher degrees of IR had higher total energy intake (3192 ± 566 vs. 2772 ± 268 vs. 2626 ± 395 kcal/d for eGDR < 5.1 vs. 5.1-8.6 vs. ≥ 8.7 mg/kg/min, p < 0.001) and consumed a higher absolute and proportional amount of fat (47.6 ± 18.6 vs. 30.4 ± 8.1 vs. 25.8 ± 10.4%, p < 0.001). After adjusting for total energy intake, age, sex, and diabetes duration, increased carbohydrate intake offset by an isoenergetic decrease in fat was associated with higher eGDR (β = 0.103, 95% CI 0.044-0.163). In contrast, increased dietary fat at the expense of dietary protein intake was associated with lower eGDR (β = - 0.119, 95% CI - 0.199 to - 0.040). Replacing fat with 5% isoenergetic amount of carbohydrate resulted in decreased vascular biomarkers (p < 0.05). CONCLUSION Higher fat, but not carbohydrate, intake is associated with increased IR and an adverse vascular profile in patients with T1D.
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Affiliation(s)
- Noppadol Kietsiriroje
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Endocrinology and Metabolism Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Hanya Shah
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Marios Zare
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
| | - Lauren L O'Mahoney
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Daniel J West
- Human Nutrition Research Centre, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Sam M Pearson
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Matthew D Campbell
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK.
- Insutiv, T1D One Life Ltd, London, UK.
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Hancock M, Burns K, Gan SK, Chew GT. Low-carbohydrate diets in type 1 diabetes: balancing benefits and risks. Curr Opin Endocrinol Diabetes Obes 2023; 30:113-122. [PMID: 36668976 DOI: 10.1097/med.0000000000000797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Interest in the use of calorie restriction with low-carbohydrate diets for patients with type 1 diabetes appears to be increasing despite physicians' discomfort about its longer term outcomes. A divergence in opinion regarding the balance of benefits and safety may lead to patient disengagement from conventional medical supervision. This review describes the current evidence regarding the benefits and risks of these diets and suggests a way forward to addressing this potential misalignment between the aims of patients and their physicians. RECENT FINDINGS Benefits on glycaemia are observed in many studies, with improved HbA1c, time within target range and reduced glycaemic variability. A characteristic lipid profile with high LDL cholesterol is observed in many patients, but association with future cardiovascular events is undefined. A negative impact on growth has been identified in the paediatric population, and impact on mental health and disordered eating is of theoretical concern, without measurement in clinical studies. SUMMARY Patients will continue to trial and, with immediate glycaemic benefits, potentially remain on lower carbohydrate diets irrespective of concern by treating physicians about potential longer term risks. A supportive multidisciplinary approach with greater nutritional supervision and more research is required, to allow these patients to achieve their desired glycaemic outcomes without compromising longer term safety.
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Affiliation(s)
- Michael Hancock
- Department of Endocrinology and Diabetes, Royal Perth Hospital
| | - Kharis Burns
- Department of Endocrinology and Diabetes, Royal Perth Hospital
- School of Medicine, University of Western Australia, Perth, Australia
| | - Seng Khee Gan
- Department of Endocrinology and Diabetes, Royal Perth Hospital
- School of Medicine, University of Western Australia, Perth, Australia
| | - Gerard T Chew
- Department of Endocrinology and Diabetes, Royal Perth Hospital
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Annan SF, Higgins LA, Jelleryd E, Hannon T, Rose S, Salis S, Baptista J, Chinchilla P, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1297-1321. [PMID: 36468223 DOI: 10.1111/pedi.13429] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- S Francesca Annan
- Paediatric Division, University College London Hospitals, London, UK
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Elisabeth Jelleryd
- Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tamara Hannon
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Shelley Rose
- Diabetes & Endocrinology Service, MidCentral District Health Board, Palmerston North, New Zealand
| | - Sheryl Salis
- Department of Nutrition, Nurture Health Solutions, Mumbai, India
| | | | - Paula Chinchilla
- Women's and Children's Department, London North West Healthcare NHS Trust, London, UK
| | - Maria Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Schneider S, Biggerstaff DL, Barber TM. Helpful or harmful? The impact of the ketogenic diet on eating disorder outcomes in type 1 diabetes mellitus. Expert Rev Endocrinol Metab 2022; 17:319-331. [PMID: 35748612 DOI: 10.1080/17446651.2022.2089112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Eating disorders (EDs) are common complications in people with type 1 diabetes (PwT1D), given the rigid focus on food and insulin dose adjustment. Dietary recommendations for T1D match those for the general population, yet many fail to achieve target HbA1c. Evidence suggests that lower carbohydrate meals and thus reduced insulin requirements may decrease inconsistencies in insulin absorption, maintain euglycemia and weight. Dietary restriction is a recognized risk factor for ED development, and Ketogenic Diets (KD) involve restriction of common family-based foods, thus impacting social normality and microbiome diversity. We reviewed the current literature on PwT1D following a KD to understand effects on ED risks. AREAS COVERED Published data from MEDLINE, Embase, and PsycINFO were used. Search terms included: type 1 diabetes mellitus; or insulin dependent diabetes or T1D AND EDs or anorexia or bulimia or disordered eating AND low-carbohydrate diet or carbohydrate restricted diet or low carb diet or ketogenic diet. EXPERT OPINION Research into the effects of KDs on ED outcomes in PwT1D are limited, given the concerns over risks of diabetic ketoacidosis, hypoglycemia, and dyslipidemia. Longer term studies on the participants' experience and motivations of adhering or admonishing the diet are needed.
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Affiliation(s)
- Suzanne Schneider
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Deborah L Biggerstaff
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
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Zaharieva DP, Riddell MC. Advances in Exercise and Nutrition as Therapy in Diabetes. Diabetes Technol Ther 2022; 24:S129-S142. [PMID: 35475701 DOI: 10.1089/dia.2022.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dessi P Zaharieva
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael C Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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