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Medical management of children with type 1 diabetes on low‐carbohydrate or ketogenic diets
Author(s) -
Rydin Amy A.,
Spiegel Gail,
Frohnert Brigitte I.,
Kaess Anne,
Oswald Lauren,
Owen Darcy,
Simmons Kimber M.
Publication year - 2021
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13179
Subject(s) - medicine , ketogenic diet , low carbohydrate , type 2 diabetes , diabetes mellitus , type 1 diabetes , pediatrics , endocrinology , epilepsy , psychiatry , obesity , weight loss
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.