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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 D, 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 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; National Institute of Virology and Bacteriology (Programme EXCELES, ID Project No. LX22NPO5103) - Funded by the European Union - Next Generation EU, 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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Marlow AL, Lawrence CM, Smith TA, Wynne K, King BR, Smart CE. Modifiable lifestyle risk factors for overweight and obesity in children and adolescents with type 1 diabetes: A systematic review. Diabetes Res Clin Pract 2024; 212:111724. [PMID: 38821415 DOI: 10.1016/j.diabres.2024.111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024]
Abstract
This review aims to identify and report epidemiological associations between modifiable lifestyle risk factors for overweight or obesity in children and adolescents with type 1 diabetes (T1D). A systematic literature search of medical databases from 1990 to 2023 was undertaken. Inclusion criteria were observational studies reporting on associations between dietary factors, disordered eating, physical activity, sedentary and sleep behaviours and measures of adiposity in children and adolescents (<18 years) with T1D. Thirty-seven studies met inclusion criteria. Studies were mostly cross-sectional (89 %), and 13 studies included adolescents up to 19 years which were included in this analysis. In adolescents with T1D, higher adiposity was positively associated with disordered eating behaviours (DEB) and a higher than recommended total fat and lower carbohydrate intake. A small amount of evidence suggested a positive association with skipping meals, and negative associations with diet quality and sleep stage. There were no published associations between overweight and physical activity, sedentary behaviours and eating disorders. Overall, the findings infer relationships between DEB, fat and carbohydrate intake and adiposity outcomes in people with T1D. Prospective studies are needed to determine causal relationships and to investigate sleep stages. High quality studies objectively measuring physical activity and include body composition outcomes are needed.
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Affiliation(s)
- Alexandra L Marlow
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia.
| | - Christopher M Lawrence
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia; Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, New South Wales, Australia.
| | - Tenele A Smith
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia.
| | - Katie Wynne
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Department of Diabetes and Endocrinology, John Hunter Hospital, New South Wales, Australia.
| | - Bruce R King
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia; Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, New South Wales, Australia.
| | - Carmel E Smart
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Hunter Medical Research Institute, New South Wales, Australia; Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, New South Wales, Australia.
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Kawashima S, Sogi C, Kamimura M, Kikuchi A, Kanno J. Severe growth retardation during carbohydrate restriction in type 1 diabetes mellitus: A case report. Clin Pediatr Endocrinol 2024; 33:181-186. [PMID: 38993724 PMCID: PMC11234184 DOI: 10.1297/cpe.2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/23/2024] [Indexed: 07/13/2024] Open
Abstract
Carbohydrate restriction is not typically recommended for children with type 1 diabetes mellitus (T1DM) because of concerns regarding growth retardation, ketoacidosis, severe hypoglycemia, and dyslipidemia. There is no consensus regarding the effects of carbohydrate restriction on the growth of children with T1DM. However, some previously reported cases of T1DM exhibited growth retardation during carbohydrate restriction, whereas others showed no obvious impairment. A female child with T1DM exhibited severe height growth velocity impairment during carbohydrate restriction in early childhood. Her height standard deviation score (SDS) was 1.12 at the initial T1DM diagnosis (2 yr and 11 mo of age) and -1.33 at 4 yr and 8 mo of age. Her height velocity was only 1.7 cm/yr (SDS -7.02). Discontinuing carbohydrate restriction substantially improved her height growth velocity. Implementing a carbohydrate-restricted diet in children with T1DM can negatively affect height growth velocity.
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Affiliation(s)
- Sayaka Kawashima
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chisumi Sogi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pediatrics, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan
| | - Miki Kamimura
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pediatrics, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Junko Kanno
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Quarta A, Guarino M, Tripodi R, Giannini C, Chiarelli F, Blasetti A. Diet and Glycemic Index in Children with Type 1 Diabetes. Nutrients 2023; 15:3507. [PMID: 37630698 PMCID: PMC10459060 DOI: 10.3390/nu15163507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
In children with type 1 diabetes, a healthy lifestyle is important to control postprandial glycemia and to avoid hyperglycemic peaks that worsen the inflammatory state of vessels and tissues. Glycemic index and glycemic load are two important indexes which assess the quality and quantity of foods consumed during meals. The main macronutrients of the diet have a different effect on postprandial blood glucose levels, so it is important that diabetic children consume foods which determine a slower and steadier glycemic peak. In this review, we present the results of the most recent studies carried out in the pediatric population with T1D, whose aim was to analyze the effects of low-glycemic-index foods on glycemic control. The results are promising and demonstrate that diets promoting low-glycemic-index foods guarantee a greater glycemic stability with a reduction in postprandial hyperglycemic peaks. However, one of the main limitations is represented by the poor adherence of children to a healthy diet. In order to obtain satisfactory results, a possibility might be to ensure a balanced intake of low-, moderate- and high-glycemic-index foods, preferring those with a low glycemic index and limiting the consumption of the high- and moderate-glycemic-index types.
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Affiliation(s)
| | | | | | | | | | - Annalisa Blasetti
- Department of Pediatrics, University of Chieti—Pescara, G. D’Annunzio, 66100 Chieti, Italy; (A.Q.); (M.G.); (R.T.); (C.G.); (F.C.)
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Quattrin T, Mastrandrea LD, Walker LSK. Type 1 diabetes. Lancet 2023; 401:2149-2162. [PMID: 37030316 DOI: 10.1016/s0140-6736(23)00223-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 04/10/2023]
Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, 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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Harray AJ, Roberts AG, Crosby NE, Shoneye C, Bebbington K. Experiences and Attitudes of Parents Reducing Carbohydrate Intake in the Management of Their Child’s Type 1 Diabetes: A Qualitative Study. Nutrients 2023; 15:nu15071666. [PMID: 37049506 PMCID: PMC10096792 DOI: 10.3390/nu15071666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
Reducing carbohydrate (CHO) intake is being used as an approach to manage type 1 diabetes (T1D) in children. This study aimed to investigate the experiences and attitudes of parents of children with T1D who are reducing CHO intake to help manage blood glucose levels (BGLs). Semi-structured interviews were conducted with the parents of children with T1D for >1 year who reported implementing a low CHO approach to manage BGLs. Data were analysed using a constant comparative analysis approach. Participants (n = 14) were parents of children (6.6 ± 2.0 years) with T1D in Western Australia. All parents reported different methods of CHO restriction and all perceived that benefits outweighed challenges. Parents reported feeling less worried, had improved sleep and felt their child was safer when using a low CHO approach due to more stable BGLs. Reported challenges included: increased cost and time spent preparing food; perceived judgement from others; and child dissatisfaction with restricted food choices. Parents reported accessing information and support through social media networks. Parents reported a desire for more research into this approach. Understanding the promoters and barriers for this dietary approach may inform strategies to better engage and support families with approaches that align with current evidence while considering their concerns around safety and hyperglycaemia.
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Affiliation(s)
- Amelia J. Harray
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Medical School, The University of Western Australia, Perth, WA 6009, Australia
- School of Population Health, Curtin University, Perth, WA 6102, Australia
- Correspondence: ; Tel.: +61-8-6456-5882
| | - Alison G. Roberts
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Naomi E. Crosby
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Charlene Shoneye
- School of Population Health, Curtin University, Perth, WA 6102, Australia
| | - Keely Bebbington
- Children’s Diabetes Centre, Telethon Kids Institute, Perth, WA 6009, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA 6009, Australia
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The Impact of a Low-Carbohydrate Diet on Micronutrient Intake and Status in Adolescents with Type 1 Diabetes. Nutrients 2023; 15:nu15061418. [PMID: 36986149 PMCID: PMC10051868 DOI: 10.3390/nu15061418] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Objective: The aim of this study was to evaluate the macronutrient and micronutrient intake and status in youth with type 1 diabetes mellitus (T1DM) following the consumption of a low-carbohydrate diet (LCD). Research Methods and Procedures: In a prospective intervention clinical trial, adolescents with T1DM using a continuous glucose monitoring device were enrolled. Following a cooking workshop, each participant received a personalized diet regime based on LCD (50–80 g carbohydrate/day). A Food Frequency Questionnaire was administered, and laboratory tests were taken before and 6 months following the intervention. Twenty participants were enrolled. Results: The median age was 17 years (15; 19), and the median diabetes duration was 10 years (8; 12). During the six-months intervention, carbohydrate intake decreased from 266 g (204; 316) to 87 g (68; 95) (p = 0.004). Energy intake, the energy percent from ultra-processed food, and fiber intake decreased (p = 0.001, p = 0.024, and p < 0.0001, respectively). These changes were accompanied by declines in BMI z-score (p = 0.019) and waist-circumference percentile (p = 0.007). Improvement was observed in the median HbA1c from 8.1% (7.5; 9.4) to 7.7% (6.9; 8.2) (p = 0.021). Significant declines below the DRI were shown in median intake levels of iron, calcium, vitamin B1, and folate. Conclusions: The LCD lowered ultra-processed food consumption, BMI z-scores and the indices of central obesity. However, LCDs require close nutritional monitoring due to the possibility of nutrient deficiencies.
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