Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study
Abstract
:1. Introduction
2. Research Design and Methods
2.1. Study Population Characteristic
2.2. Assessment of Dietary Habits
2.3. Clinical and Laboratory Data
2.4. Statistical Analysis
3. Results
3.1. Frequency of the LCD among the Responders
3.2. Comparison of LCD Subjects to Their Non-LCD Matched Controls
3.3. Questions Specific for the LCD Group
3.4. Comparison of the VLCD Sub-Group to LCD Subjects
4. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
CGM | continuous glucose monitoring |
CV | glucose coefficient of variation |
LCD | low-carbohydrate diet |
SD | standard deviation of glycemia |
SDS | standard deviation score |
VLCD | very low-carbohydrate diet |
References
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Low-Carbohydrate Diet | Non-LCD Diet | p-Value | |
---|---|---|---|
Subjects | N = 36 | N = 36 | |
Demographics | |||
Age at survey collection (years) | 11.9 (6.1) | 11.8 (5.6) | 0.03 * (0.06) |
Sex | F = 25 (69.4%) M = 11 (30.6%) | F = 25 (69.4%) M = 11 (30.6%) | - |
Age at T1D onset (years) | 8.0 (7.1) | 8.4 (5.6) | 0.11 (0.21) |
T1D duration (years) | 3.2 (2.7) | 3.7 (3.5) | 0.74 (0.87) |
Anthropometric data | |||
Body height (cm) | 0.54 (0.57) | ||
Body height SDS | −0.4 (1.4) | 0.3 (1.2) | 0.35 (0.42) |
Body weight (kg) | 0.62 (0.66) | ||
Body weight SDS | 0.5 (1.2) | 0.4 (1.0) | 0.68 (0.72) |
Body mass index SDS | 0.5 (1.3) | 0.5 (0.9) | 0.62 (0.68) |
Systolic arterial blood pressure (centile) | 43 (63.0) | 73.5 (40.8) | 0.03 * (0.008 **) |
Diastolic arterial blood pressure (centile) | 61 (32.5) | 76.5 (39.8) | 0.17 (0.08) |
LCD data | |||
Daily carbohydrate intake (g) | 96.5 (42) | 170 (39.8) | <0.001 *** (<0.001 ***) |
Age at LCD start (years) | 11.2 | - | - |
LCD duration (years) | 1.1 | - | - |
LCD type | LCD = 31 (86.1%) VLCD = 5 (13.8%) | - | - |
Treatment and T1D control | |||
Treatment type | MDI = 27 (75%) CSII = 9 (25%) | MDI = 27 (75%) CSII = 9 (25%) | - |
Bolus insulin (units daily) | 10.0 (10.4) | 21.5 (16.8) | <0.001 *** (<0.001 ***) |
Basal insulin (units daily) | 12.0 (12.7) | 13.5 (11.6) | 0.76 (0.60) |
Total insulin daily dose (units/kg/day) | 0.6 (0.3) | 0.8 (0.3) | <0.001 *** (<0.001 ***) |
Last HbA1c (mmol/mol) | 45.0 (9.5) | 49.5 (15.2) | 0.11 (0.26) |
Last HbA1c (%) | 6.3 (3.0) | 6.7 (3.6) | 0.11 (0.26) |
Average HbA1c during the last year (mmol/mol) | 47.9 (10.3) | 50.9 (10.6) | 0.05 (0.11) |
Average HbA1c during the last year (%) | 6.5 (3.1) | 6.8 (3.1) | 0.05 (0.11) |
CGM data | |||
CGM use | Yes = 35 (97.2%) No = 1 (2.8%) | Yes = 34 (94.4%) No = 2 (5.6%) | 0.75 (0.75) |
Time in range 3.9–10.0 mmol/L (%) | 74.0 (14.5) | 66.5 (16.4) | 0.02 * (0.05) |
Time below 3.9 mmol/L (%) | 8.0 (8.0) | 5.0 (6.0) | 0.05 (0.25) |
Time below 3.0 mmol/L (%) | 2.0 (3.0) | 1.0 (4.5) | 0.78 (0.89) |
Time above 10.0 mmol/L (%) | 17.0 (15.9) | 20.0 (9.0) | 0.04 * (0.20) |
Time above 13.9 mmol/L (%) | 2.0 (4.0) | 3.0 (5.0) | 0.04 * (0.07) |
Average glycemia (mmol/L) | 7.0 (1.2) | 7.9 (2.1) | 0.02 * (0.05) |
Standard deviation of glycemia | 2.6 (1.0) | 3.2 (0.8) | 0.03 * (0.07) |
Coefficient of variation (%) | 37.4 (8.0) | 39.5 (11.8) | 0.60 (0.80) |
Lipid spectrum | |||
Total cholesterol (mmol/L) | 4.8 (0.8) | 4.7 (1.4) | 0.55 (0.83) |
Triglycerides (mmol/L) | 0.9 (0.5) | 0.9 (0.6) | 0.29 (0.08) |
HDL cholesterol (mmol/L) | 1.5 (0.5) | 1.7 (0.4) | 0.23 (0.46) |
LDL cholesterol (mmol/L) | 2.6 (0.9) | 2.7 (1.1) | 0.57 (0.98) |
Question | Answer | N | % |
---|---|---|---|
Who initiated carbohydrate restriction? | The child/adolescent with T1D | 18/67 | 26.8 |
The parent/caregiver | 42/67 | 62.7 | |
The diabetologist | 6/67 | 8.9 | |
No answer | 1/67 | 1.5 | |
Did you consult your intention to reduce carbohydrate intake with your diabetologist? | No | 26/67 | 38.8 |
Yes, he/she supported us | 18/67 | 26.9 | |
Yes, he did not support us nor discouraged us but explained the risks and benefits | 17/67 | 25.4 | |
Yes, he/she discouraged us | 4/67 | 6.0 | |
What was the reason for carbohydrate restriction? * | Better T1D control | 46/67 | 68.7 |
Lower insulin dose | 20/67 | 29.9 | |
Reduction of body weight | 12/67 | 17.9 | |
Healthy lifestyle | 40/67 | 59.7 | |
What were your sources of information on carbohydrate restriction? * | Internet | 42/67 | 62.7 |
Books | 23/67 | 34.3 | |
Other families with T1D children | 27/67 | 40.3 | |
Diabetologist | 16/67 | 23.9 | |
Have you noticed any changes after the initiation of carbohydrate restriction? If so, which? * | No | 9/67 | 13.4 |
Better T1D control | 32/67 | 47.8 | |
Lower insulin dose | 40/67 | 59.7 | |
Body weight reduction | 21/67 | 31.3 | |
Increased fatigue | 7/67 | 10.4 | |
More frequent hypoglycemia | 12/67 | 17.9 | |
School-related conflict | 4/67 | 6.0 | |
Conflicts with diabetologist | 1/67 | 1.5 | |
Family conflict | 7/67 | 10.4 | |
Increased costs for meal preparation | 13/67 | 19.4 | |
Increased time for meal preparation | 15/67 | 22.4 | |
Hunger | 1/67 | 1.5 | |
Did you/your child find low-carbohydrate meals tasty? | Yes, or mostly yes | 29/67 | 43.3 |
Depending on the meal | 26/67 | 38.8 | |
No, or mostly no | 11/67 | 16.4 | |
Did you/your child with T1D have severe hypoglycemia requiring hospitalization during the time you reduced carbohydrates? | Yes | 2/67 | 3.0 |
No | 65/67 | 97.0 | |
Did you/your child with T1D have diabetic ketoacidosis requiring hospitalization during the time you reduced carbohydrates? | Yes | 0/67 | 0.0 |
No | 67/67 | 100.0 | |
Would you recommend carbohydrate restriction to other children/adolescents with T1D? | Yes | 49/67 | 73.1 |
No | 18/67 | 26.9 | |
Who initiated the termination of carbohydrate restriction? † | The child/adolescents with T1D | 14/31 | 45.2 |
The parent/caregiver | 14/31 | 45.2 | |
The diabetologist | 3/31 | 9.7 | |
What were the reasons for the termination of carbohydrate restriction? *,† | It did not fulfill our expectations | 13/31 | 41.9 |
Non-adherence on the side of child/adolescent with T1D | 16/31 | 51.6 | |
Side-effects (fatigue, frequent hypoglycemia) | 7/31 | 22.6 | |
Financial costs | 2/31 | 6.5 | |
Time consumption | 4/31 | 12.9 | |
School-related conflict | 2/31 | 6.5 | |
Family conflict | 1/31 | 3.2 | |
No answer | 2/31 | 6.5 |
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Neuman, V.; Plachy, L.; Pruhova, S.; Kolouskova, S.; Petruzelkova, L.; Obermannova, B.; Vyzralkova, J.; Konecna, P.; Vosahlo, J.; Romanova, M.; et al. Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study. Nutrients 2021, 13, 3903. https://doi.org/10.3390/nu13113903
Neuman V, Plachy L, Pruhova S, Kolouskova S, Petruzelkova L, Obermannova B, Vyzralkova J, Konecna P, Vosahlo J, Romanova M, et al. Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study. Nutrients. 2021; 13(11):3903. https://doi.org/10.3390/nu13113903
Chicago/Turabian StyleNeuman, Vit, Lukas Plachy, Stepanka Pruhova, Stanislava Kolouskova, Lenka Petruzelkova, Barbora Obermannova, Jana Vyzralkova, Petra Konecna, Jan Vosahlo, Martina Romanova, and et al. 2021. "Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study" Nutrients 13, no. 11: 3903. https://doi.org/10.3390/nu13113903
APA StyleNeuman, V., Plachy, L., Pruhova, S., Kolouskova, S., Petruzelkova, L., Obermannova, B., Vyzralkova, J., Konecna, P., Vosahlo, J., Romanova, M., Pavlikova, M., & Sumnik, Z. (2021). Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study. Nutrients, 13(11), 3903. https://doi.org/10.3390/nu13113903