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February 20 2025
The Society of Metabolic Health Practitioners recently published a position statement on therapeutic carbohydrate reduction for type 1 diabetes in the...
The Society of Metabolic Health Practitioners recently published a position statement on therapeutic carbohydrate reduction for type 1 diabetes in the Journal of Metabolic Health. Noting that nearly 80 percent of adults with type 1 diabetes (T1D) in the US don’t achieve the American Diabetes Association’s (ADA’s) target hemoglobin A1c goal of <7.0% and that children and adolescents with this condition fare even worse, the authors make the case that very-low-carbohydrate and ketogenic diets may be a better strategy than the traditional “carb counting” approach.
Noting that carb counting often has disappointing results, the authors wrote, “Current standard treatment approaches have resulted in unsatisfactory real-world clinical results with elevated hemoglobin A1C and unacceptable rates of complications.”
They also pointed out that while the ADA purports to support a variety of different diets, the recommended approaches may still be too high in carbs to achieve the best outcomes: “Although the ADA guidelines recommend reducing total carbohydrate and sugar intake using a variety of eating patterns, all dietary patterns presented, with the exception of a low-carbohydrate approach, still include starches, legumes, and grains.” They present evidence that a stricter approach to carbohydrate reduction may be more effective for improving glycemic control and decreasing the amount of insulin required – thereby reducing volatility in blood sugar as well as risk for “double diabetes,” and reducing risk for long-term complications.
Diabetic ketoacidosis (DKA) is a serious concern among those with T1D, but research trials and clinical case studies indicate no increased risk for DKA among individuals following therapeutic carbohydrate restriction (TCR) compared to prevailing rates.
For the purpose of the position statement, TCR was described as a low-carbohydrate diet (<130 grams of carbs per day) or a very low-carbohydrate diet (<50 grams or fewer per day). The evidence for improved outcomes appears to be stronger at the lower end of the spectrum for daily carb intake, but it is noted that even modest reductions in carb intake (from 50% of daily calories to 30%, for example) can improve glycemic control and diabetes outcomes.
See these articles for more information regarding dietary carbohydrate restriction for T1D:
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