Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;141(6):e20173349.
doi: 10.1542/peds.2017-3349. Epub 2018 May 7.

Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet

Belinda S Lennerz  1   2 , Anna Barton  3 , Richard K Bernstein  4 , R David Dikeman  5 , Carrie Diulus  6 , Sarah Hallberg  7 , Erinn T Rhodes  1 , Cara B Ebbeling  1   2 , Eric C Westman  8 , William S Yancy Jr  8 , David S Ludwig  9   2
Affiliations

Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet

Belinda S Lennerz et al. Pediatrics. 2018 Jun.

Abstract

Objectives: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD).

Methods: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records.

Results: Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia.

Conclusions: Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Bernstein reported receiving royalties for books on the management of diabetes (which were used by members of the online social media group surveyed in this study). Dr Hallberg reported stock options and research support from Virta Health, a company that provides health care services for type 2 diabetes, and consulting fees from Atkins. Dr Rhodes is the site principal investigator in clinical trials for pediatric type 2 diabetes that are sponsored by Merck and AstraZeneca. Dr. Westman has ownership interest in companies using low-carbohydrate principles, and he receives royalties for books related to low-carbohydrate diets. Dr Ludwig reported receiving royalties from books on nutrition and obesity; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Enrollment. a The primary end point, current HbA1c, was available in the appropriate time frame (at least 3 months after starting the VLCD) for 300 participants. Data from all 316 eligible participants are included in the other analyses.
FIGURE 2
FIGURE 2
HbA1c distribution. The adult (light gray) and pediatric (dark gray) age groups are shown (n = 300).
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Newburgh LH, Marsh PL. The use of a high fat diet in the treatment of diabetes mellitus. Arch Intern Med (Chic). 1921;27(6):699–705
    1. American Diabetes Association Nutritional recommendations and principles for individuals with diabetes mellitus: 1986. American Diabetes Association. Diabetes Care. 1987;10(1):126–132 - PubMed
    1. Armstrong C. ADA updates standards of medical care for patients with diabetes mellitus. Am Fam Physician. 2017;95(1):40–43 - PubMed
    1. Miller KM, Foster NC, Beck RW, et al. ; T1D Exchange Clinic Network . Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D exchange clinic registry. Diabetes Care. 2015;38(6):971–978 - PubMed
    1. Rohlfing CL, Wiedmeyer HM, Little RR, England JD, Tennill A, Goldstein DE. Defining the relationship between plasma glucose and HbA(1c): analysis of glucose profiles and HbA(1c) in the Diabetes Control and Complications Trial. Diabetes Care. 2002;25(2):275–278 - PubMed

Publication types