Low-Carbohydrate and Ketogenic Diets in Adults with Type 1 and Type 2 Diabetes
Bibliographic record
Abstract
Low-carbohydrate diets (LCDs) have increasingly gained interest in the diabetes community over the last two decades. The ketogenic diet (KD) is a variation of a LCD which is very-low in carbohydrates (CHO) and high in fat. These diets continue to intrigue individuals despite the lack of strong, long-term evidence. The first part of this thesis aims to better understand the experience of adults with diabetes with following the KD, such as reasons to start the diet, motivators, support systems, sources of information, and challenges. Methods: In this qualitative study, adults living with type 1 (T1D) or type 2 (T2D) diabetes and following the KD for ≥3 months were recruited. 14 semistructured interviews were conducted in-person, audio-recorded, and transcribed. Thematic analysis by concept mapping was conducted. Results: Participants were 54.5±10.1 years old and followed the KD for 6 to 19 (median 5) months; 43% were male and 79% had type 2 diabetes. The main motivation to start the KD was to improve glycemic control or to reduce/stop taking diabetes medications. Social disapproval and lack of support from a health-care professional were the main challenges, which were prevailed by self-reported benefits such as improved glycemic control, weight loss, and increased satiety. Conclusion: A wide range of self-reported benefits strongly motivated individuals to follow the KD despite the lack of safety information and/or support. Furthermore, there is a particular concern of the safety of LCDs, particularly the KD, in individuals with T1D where injected insulin doses need to match CHO intake for proper glycemic control. In addition, higher fat intake, as in LCDs and KDs, may aggravate blood lipids in individuals with T1D, who already have an increased risk of cardiovascular (CV) events. Manuscript 2 aims to evaluate the relationship of LCD, assessed using a LCD score, with glycemic control and CV risk factors in adults with T1D. Methods: This cross-sectional study used data collected in a T1D registry in Québec, including self-reported or measured anthropometric data, history of moderate and severe hypoglycemic episodes, impaired awareness of hypoglycemia (Clarke score ≥4), and biochemical data (hemoglobin A1c (HbA1c), LDL-cholesterol, and non-HDL-cholesterol). 24-hour dietary recalls were collected and ranked by each macronutrient in order to calculate the LCD score. Participants were divided into quartiles (Q) based on LCD scores. Results: 285 adults (aged 48.2±15.0 years; T1D duration of 25.9±16.2 years) were included. Overall, participants reported low carbohydrate and fiber intakes and high fat intake compared to recommendations. Mean carbohydrate intake ranged from 31.2±6.9% (Q1) to 56.5±6.8% of total energy (Q4). Compared to Q4, more people in Q1 reported HbA1c ≤7% (Q1: 53.4% vs Q4: 29.4%; P=0.011). Compared to Q3, more people in Q1 reported no history of severe hypoglycemia (Q1: 60.0% vs Q3: 31.0%; P=0.004). There were no differences between quartiles for frequency of moderate hypoglycemia events (P=0.784), impaired awareness of hypoglycemia (P=0.269) and lipid profile: LDL-cholesterol (P=0.290) and non-HDL-cholesterol (P=0.118). Conclusions: Low carbohydrate intake is associated with a higher probability of reaching HbA1c target and lower frequency of history of severe hypoglycemia, but not with moderate hypoglycemia frequency, impaired hypoglycemia awareness, nor CV risk factors.LCDs appear to have benefits on glycemic control in adults with both T1D and T2D. As LCDs continue to gain interest in the diabetes community, it is important to acknowledge possible adverse effects on glycemic control as well as lifestyle and social challenges when following these diets. Further long-term studies of the effect of LCDs in T1D and T2D are needed to help HCPs establish clinical recommendations for individuals wishing to follow these diets
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".