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A moderate low-carbohydrate diet for adults with type 1 diabetes has advantages over traditional diet. The average blood sugar level is reduced and the time with good values during a 24 hour period is increased, without any negative health impact. This has been shown in a study carried out at the University of Gothenburg.

The study published in The Lancet Regional Health - Europe is the largest of its kind to date. Participants were for different periods randomly assigned in a crossover manner to eat a traditional diet with 50% of the energy from carbohydrates, or a moderate low-carbohydrate diet with 30% of the energy from carbohydrates.

This is a moderate reduction in carbohydrates, with 24-hour monitoring of all participants via continuous glucose monitoring (CGM). Blood glucose levels were recorded at least every 15 minutes during the 16 weeks of the study, and were followed up by a dietitian and diabetes nurse.

The Lancet Regional Health - Europe
Available online 19 December 2023, 100799
In Press

The effect of carbohydrate intake on glycaemic control in individuals with type 1 diabetes: a randomised, open-label, crossover trial


https://doi.org/10.1016/j.lanepe.2023.100799

Summary
Background
Few studies have examined the effects of lower carbohydrate diets on glucose control in persons with type 1 diabetes (T1D). The objective of the study was to investigate whether a moderate carbohydrate diet improves glucose control in persons with T1D.

Methods
A randomised, multicentre, open-label, crossover trial over 12 weeks. There were 69 individuals assessed for eligibility, 54 adults with T1D and HbA1c ≥ 58 mmol/mol (7.5%) were randomised. Interventions were moderate carbohydrate diet versus traditional diet (30 vs 50% of total energy from carbohydrates) over four weeks, with a four-week wash-out period between treatments. Masked continuous glucose monitoring was used to evaluate effects on glucose control. The primary endpoint was the difference in mean glucose levels between the last 14 days of each diet phase.

Findings
50 individuals were included in the full analysis set with a mean baseline HbA1c of 69 mmol/mol (8.4%), BMI 29 kg/m2, age of 48 years, and 50% were female. The difference in mean glucose levels between moderate carbohydrate and traditional diet was −0.6 mmol/L, 95% CI −0.9 to −0.3, p < 0.001. Time in range increased during moderate carbohydrate diet by 4.7% (68 min/24 h) (95% CI 1.3 to 8.0), p = 0.008. Time above range (>10 mmol/L) decreased by 5.9% (85 min/24 h), 95% CI −9.6 to −2.2, p = 0.003. There were no significant differences in the standard deviation of glucose levels (95% CI −0.3 to 0.0 mmol/L, p = 0.15) or hypoglycaemia in the range <3.9 mmol/L (95% CI −0.4 to 2.9%, p = 0.13) and <3.0 mmol/L (95% CI −0.4 to 1.6%, p = 0.26). Four participants withdrew, none because of adverse events. There were no serious adverse events including severe hypoglycaemia and ketoacidosis. Mean ketone levels were 0.17 (SD 0.14) mmol/L during traditional and 0.18 (SD 0.13) mmol/L during moderate carbohydrate diet (p = 0.02).

Interpretation
A moderate carbohydrate diet is associated with decreases in mean glucose levels and time above range and increases in time in range without increased risk of hypoglycaemia or ketoacidosis compared with a traditional diet in individuals with T1D.