Reducing Carbohydrates Improves Diabetes Control in Children
A wide-ranging international study has shown that children with type 1 diabetes who follow a very low-carbohydrate diet may experience improved blood sugar control and reduced insulin requirements, without evidence of an increased risk of certain severe diabetes complications. The study’s results, led by the University Medical Center in Ulm, Germany, in collaboration with Boston Children’s Hospital and Harvard Medical School in the United States, were presented at the annual meeting of the European Association for the Study of Diabetes, currently held in Milan, Italy.
Type 1 diabetes is a chronic condition in which the immune system attacks the insulin-producing cells in the pancreas, leading to a deficiency or complete absence of insulin. Patients require daily insulin use to maintain blood sugar levels within the target range, and the disease often appears in childhood or adolescence.
Low-carbohydrate diets have gained attention among some families of children with type 1 diabetes, aiming to improve blood sugar control and reduce insulin needs, despite concerns about potential nutrient deficiencies, elevated cholesterol, hypoglycemia, diabetic ketoacidosis, and effects on growth. Low-carbohydrate diets are eating patterns that reduce the intake of carbohydrates, such as bread, rice, grains, potatoes, and sugars, while relying more heavily on protein, fats, and low-carbohydrate vegetables.
To assess these concerns, researchers analyzed 25 years of data from a German registry tracking patients with diabetes. The study included more than 45,000 children aged 1 to 17, with a mean age of 10 years. Each child’s carbohydrate consumption was recorded at least twice during a follow-up period of one year or more. Researchers categorized the children into three groups based on the percentage of total energy intake from carbohydrates: a very low-carbohydrate diet (less than 10%), comprising 219 children; a low-carbohydrate diet (10% to less than 26%), comprising 4,837 children; and a standard or higher-carbohydrate diet (26% or more), comprising 40,513 children.
The researchers found no evidence that very low-carbohydrate diets impair growth or increase the incidence of severe hypoglycemia or diabetic ketoacidosis. Conversely, lower carbohydrate consumption was associated with improved body mass index and blood sugar control, along with lower levels of hemoglobin A1c (HbA1c) and basal insulin doses at the end of the follow-up period, and a slower rise in these measures over time. The IDAA1c index, which combines glycated hemoglobin levels and daily insulin dose, also decreased among children following low-carbohydrate diets, indicating better blood sugar control without increased insulin doses. Although the researchers adjusted for factors such as age, sex, and duration of diabetes, they emphasized that the study is observational and does not prove that reducing carbohydrates is the direct cause of these improvements.
The researchers concluded that the results are encouraging but require further studies to confirm them, determine the optimal amount of carbohydrates that achieves the desired benefits while maintaining children’s growth and dietary diversity.
