A New “Old” Method of Glycemic Control in Diabetes: The Very-Low-Carbohydrate Diet!
LewisFirst, MD, MS, Editor in Chief, Pediatrics
While there are certainly risks to sharing information via social media, there can
also be benefits. Take parents of children with type 1 diabetes who are always looking
for new ways to better control this illness in their offspring. While insulin has
been the focus for establishing better control of blood sugars for nearly 100 years,
diet is quickly becoming another area for exploration. One way to learn about new
dietary treatments is through networks of groups of patients who share information
with each other through the Internet and social media about their dietary habits.
Lennerz et al. (10.1542/peds.2017-3349) surveyed an international social media group of parents of children with type 1
diabetes who they discovered had placed their children on a very-low-carbohydrate
diet (VLCD) (≤30 grams per day of mostly fibrous vegetables and nuts) for at least
three months. Interestingly, a VLCD was a treatment used in the pre-insulin era.
The authors identified 131 parents whose children had type 1 diabetes (validated
by medical records and provider surveys) and asked detailed questions about the diet
their children were on as well as metrics of glycemic control. The study group participants
reported their children being on this unique VLCD diet for a mean of 2.2 years and
that they had a mean carbohydrate intake of on average 36 grams. What is remarkable
is that they also reported that the mean Hgb A1C of children on this diet (average
age 16 years), was 5.67% with only a small number of hospitalizations in the past
year, 4 for ketoacidosis and 2 for hypoglycemia. You have to be impressed with the
low level of HgbA1C achieved in association with this diet as well as the low rate
of hospitalizations, despite over 130 children being included in this survey study.
Yet it’s a survey study and thus does not prove a causal role for the very-low-carbohydrate
diet—or does it?
We asked endocrinologist Dr. Joyce Lee and nutritionist Carly Runge to further explore
the implications of this study in an accompanying commentary (10.1542/peds.2018-0957). They share their excitement about the findings in this study but also caution
readers to be aware of possible limitations a study like this can have—such no way
to prove that children stayed on this diet for the entire time or what they specifically
ate over that time. Drs. Lee and Runge call for a future randomized controlled trial,
as should all readers of this study to determine if this diet is really a therapeutic
option. While we hope your thoughts about this exciting new “old” dietary finding
for managing diabetes stay under control, we also hope you will read the study and
commentary in more detail, so you can weigh the benefits and risks of having your
patients on a VLCD diet, if they ask you about it as a result of this study gaining
the public attention it is likely to do.