Carbohydrate-restricted diets and Type 1 diabetes mellitus: research considerations.

PURPOSE OF REVIEW: Type 1 diabetes mellitus (T1DM) is managed via careful control of blood glucose, exogenous insulin, diet, exercise, and other physiologic factors. Interestingly, the dietary recommendations for T1DM have had very little systematic research. Many clinical observations, as well as emerging research studies, have noted that a carbohydrate-restricted diet can lead to normalization of blood glucoses with reduction in hypoglycemic reactions among motivated individuals.

RECENT FINDINGS: In this paper, we review observations of carbohydrate restriction and propose a series of studies to test two levels of dietary carbohydrate intake for the management of individuals affected by T1DM. We recommend that the studies start in otherwise healthy adults with hemoglobin A1c > 8%, and then progress to more complicated populations including children, those with secondary complications and/or good glycemic control. Larger, long-term studies would then address growth in children, and diabetic complications including cardiovascular outcomes.

SUMMARY: Due to the clinical observations of improvements using carbohydrate-restricted nutrition for T1DM, we recommend that these types of studies addressing the level of dietary carbohydrate be urgently conducted.