Medical management of children with type 1 diabetes on low‐carbohydrate or ketogenic diets. Issue 3 (16th February 2021)

• Record Type: Journal Article
• Authors: Rydin, Amy A.; Spiegel, Gail; Frohnert, Brigitte I.; Kaess, Anne; Oswald, Lauren; Owen, Darcy; Simmons, Kimber M.
• Is Part Of: Pediatric diabetes. Volume 22:Issue 3(2021)
• Page Start: 448
• Page End: 454
• Publication Date: 2021-02-16
• Subjects: type 1 diabetes mellitus -- carbohydrate‐restricted diet -- ketogenic diet -- pediatrics; Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.13179
• Languages: English
• ISSNs: 1399-543X

Abstract

Abstract: Objectives: Low‐carbohydrate and ketogenic diets are becoming increasingly popular choices for people with type 1 diabetes (T1D) aiming to achieve optimal glycemic control. A carbohydrate‐restricted diet in children has been associated with negative health effects including poor linear growth and inadequate bone mineralization. Guidelines for monitoring children and adolescents choosing to follow a carbohydrate‐restricted diet do not exist. We aimed to create a clinical protocol outlining how to clinically and biochemically follow patients choosing a carbohydrate‐restricted diet with the goal of medical safety. Methods: An interdisciplinary committee was formed and reviewed current consensus guidelines for pediatric patients on carbohydrate‐restricted diets for epilepsy and metabolic disorders. A literature search was done to determine management strategies for children with T1D on a low‐carbohydrate or ketogenic diet. Key health parameters that require monitoring were identified: growth, glycemic control, bone health, cardiometabolic health, and nutritional status. These health outcomes were used to develop a protocol for monitoring children on carbohydrate‐restricted diets. Results: A one‐page protocol for medical providers and educational materials for families interested in following a low‐carbohydrate or ketogenic diet were developed and successfully implemented into clinical care. Conclusion: Implementing a protocol for children on carbohydrate‐restricted diets in clinic allows medical providers to ensure medical safety while being open to discussing a family's dietary preferences. Following children in the protocol over time will lead to informed clinical guidelines for patients with T1D who choose to follow a carbohydrate‐restricted diet.