Impact of low carbohydrate diet on Type 1 Diabetic patients

Abstract

Type 1 diabetes presents a significant challenge to the patient and the healthcare providers to achieve and maintain recommended glycemic control. The recommendations for dietary carbohydrates varied over the years from severe restriction to no restriction.

We aimed to study the effect of low carbohydrate diet on glycemic control and other metabolic parameters in subjects with type 1 diabetes. Glycemic control was assessed clinically as improvement in frequency of hypoglycemia and hyperglycemia and total daily insulin dose. The laboratory evidence was improvement in HbA1c. The metabolic profile was assessed clinically by measuring weight, BMI, Body fat percent and skeletal muscle mass. The laboratory assessment was made by measuring the lipid profile, liver enzymes, albumin, serum creatinine, hemoglobin and urinary albumin creatinine ratio.

We conducted an open label single arm interventional study in which 46 uncontrolled (HbA1c ≥7%), subjects with type 1 diabetes on a standard carbohydrate diet, were placed on low carbohydrate diet (<26% of daily caloric intake). Patients attending Ain Shams University hospitals outpatient diabetes clinics were invited to participate. Participants were provided with education sessions to achieve and maintain low carbohydrate diet. They visited the clinic at baseline, 3 and 6 months.

Repeated measure analysis of variance was used to assess the difference between mean values. Low carbohydrate diet resulted in significant improvement (p<0.001) in all parameters of glycemic control including HbA1c, episodes of hypoglycemia and hyperglycemia and total daily insulin dose. There was a significant improvement in the metabolic panel in the form of significantly lower body weight, BMI percent body fat and a significantly higher skeletal muscle mass. There was a significant reduction in Total cholesterol, LDL and triglycerides. The liver enzymes and urinary albumin/creatinine ratio showed a significant decline while remaining in the normal reference range. A non-significant change was noted in HDL, hemoglobin, and creatinine.