What Should be the Ideal Carbohydrate Intake in Type 1 Diabetes?: A Literature Review

Öz

The purpose of this literature review is to assess the impact of carbohydrate intake through diet on postprandial glycemia for individuals with type 1 diabetes and to provide insight into the recommended carbohydrate intake outlined in national and international guidelines by determining ideal intake quantities. A literature search and standard data extraction were conducted using Google Scholar, PubMed, and Web of Science Databases. The literature review spanned from January to June 2023. Given the limited number of studies involving individuals with type 1 diabetes, a total of 7 research articles were thoroughly examined. While both long-term and short-term studies have investigated high- and low-carbohydrate diets in type 1 diabetes, only one study design was found that explored the effects of closely related ratios (comparing 45% to 50%) on postprandial glycemia. Although many studies have primarily concentrated on low-carb diets, there exists a gap in the scientific literature despite some evidence indicating potential glycemic improvements in individuals with type 1 diabetes on such diets. It's noted that adopting such a diet might elevate the risk of cardiovascular diseases in the long run and potentially hinder growth, particularly in children. This literature review has identified various interventions with positive impacts on glycemic control for different levels of carbohydrate intake. General recommendations from guidelines developed for individuals with type 1 diabetes suggest that 50% of total energy intake should come from carbohydrates, with a preference for complex carbohydrate sources.

Anahtar Kelimeler

• Type 1 diabetes
• carbohydrate intake
• postprandial glycemia

Tip 1 Diyabette İdeal Karbonhidrat Alımı Ne Olmalıdır?: Literatür Taraması

Öz

Bu literatür taramasının amacı, tip 1 diyabetli bireylerde diyette karbonhidrat alımının postprandiyal glisemi üzerindeki etkisini değerlendirmek ve ideal alım miktarlarını belirleyerek ulusal ve uluslararası kılavuzlarda belirtilen önerilen karbonhidrat alımına ilişkin fikir sağlamaktır. Google Akademik, PubMed ve Web of Science veritabanları kullanılarak literatür taraması yapılmıştır. Literatür taraması Ocak-Haziran 2023 dönemini kapsamaktaydı. Tip 1 diyabetli bireyleri kapsayan sınırlı sayıdaki çalışma göz önüne alındığında, toplam 7 araştırma makalesi kapsamlı bir şekilde incelenmiştir. Hem uzun süreli hem de kısa süreli çalışmalar tip 1 diyabette yüksek ve düşük karbonhidratlı diyetleri araştırırken, yakın oranların (%45 ila %50'yi karşılaştıran) postprandiyal glisemi üzerindeki etkilerini araştıran yalnızca bir çalışma tasarımı bulunmuştur. Pek çok çalışma öncelikle düşük karbonhidratlı diyetler üzerine yoğunlaşmış olsa da, bu tür diyetler uygulayan tip 1 diyabetli bireylerde potansiyel glisemik iyileşmeler olduğunu gösteren bazı kanıtlara rağmen bilimsel literatürde bir boşluk bulunmaktadır. Bu diyetlerin benimsenmesinin uzun vadede kardiyovasküler hastalık riskini artırabileceği ve özellikle çocuklarda büyümeyi engelleyebileceği belirtilmektedir. Bu literatür incelemesi, farklı karbonhidrat alımı seviyeleri için glisemik kontrol üzerinde olumlu etkileri olan çeşitli müdahaleleri tanımlamıştır. Tip 1 diyabetli bireyler için geliştirilen kılavuzlardaki genel öneriler, toplam enerji alımının %50'sinin karbonhidratlardan gelmesi gerektiğini ve kompleks karbonhidrat kaynaklarının tercih edilmesini önermektedir.

Anahtar Kelimeler

• Tip 1 diyabet
• karbonhidratlı alımı
• postprandial glisemi

Kaynakça

1. 1. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. The Lancet. 2018;391(10138):2449–2462. doi: 10.1016/S0140-6736(18)31320-5.
2. 2. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: International Diabetes Federation, 2021. [cited 2023 Jun 7]. Available from: URL: https://diabetesatlas.org/idfawp/resource-files/2021/11/IDF-Atlas-Factsheet-2021_EUR.pdf.
3. 3. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37:120143. doi: 10.2337/dc14-S120.
4. 4. Hamdy O, Barakatun-Nisak MY. Nutrition in diabetes. Endocrinology and Metabolism Clinics. 2016;45(4):799-817. doi: 10.1016/j.ecl.2016.06.010.
5. 5. Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatric Diabetes. 2018;19:136-154.
6. 6. American Diabetes Association. 5. Facilitating behavior change and well-being to ımprove health outcomes: Standards of medical care in diabetes—2021. Diabetes Care. 2021;44:53–72. doi: 10.2337/dc21-S005.
7. 7. Dimosthenopoulos C, Liatis S, Kourpas E, et al. The beneficial short‐term effects of a high‐protein/low‐carbohydrate diet on glycaemic control assessed by continuous glucose monitoring in patients with type 1 diabetes. Diabetes, Obesity and Metabolism. 2021;23(8):1765-1774. doi: 10.1111/dom.14390.
8. 8. Diabetes Diagnosis and Treatment Guidelines. Medical Nutrition Therapy and Exercise.Turkish Diabetes Foundation. Diabetes diagnosis and treatment guide 2021. Armoni Nuans Printing Arts. 2021:55.

9. 9. Türkiye Beslenme Rehberi (TUBER)-2022. T.R. Ministry of Health Publication No: 1031, Ankara, 2022.
10. 10. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2018:42(Suppl 1):1-325.
11. 11. National Institute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. https://www.nice.org.uk/guidance/ng18. Published August 2015. Update date May 2023.
12. 12. Craig ME, Twigg SM, Donaghue KC, et al. Australian Type 1 Diabetes Guidelines Expert Advisory Group. National evidence-based clinical care guidelines for type 1 diabetes in children, adolescents and adults, Australian Government Department of Health and Ageing: Canberra; 2011.
13. 13. Mackey ER, O'Brecht L, Holmes CS, Jacobs M, Streisand R. Teens with type 1 diabetes: How does their nutrition measure up? J Diabetes Res. 2018;6:2018:5094569. doi: 10.1155/2018/5094569.
14. 14. Meissner T, Wolf J, Kersting M, et al. Carbohydrate intake in relation to BMI, HbA1c and lipid profile in children and adolescents with type 1 diabetes. Clinical Nutrition. 2014;33(1):75–78. doi: 10.1016/j.clnu.2013.03.017.
15. 15. Araki E, Goto A, Kondo T, et al. Japanese clinical practice guideline for diabetes 2019. Diabetology International. 2020;11:165-223.
16. 16. Ayano‐Takahara S, Ikeda K, Fujimoto S, et al. Carbohydrate intake is associated with time spent in the euglycemic range in patients with type 1 diabetes. Journal Of Diabetes Investigation. 2015;6(6):678-686. doi: 10.1111/jdi.12360.
17. 17. Dyson P. Low carbohydrate diets and type 2 diabetes: What is the latest evidence? Diabetes Therapy. 2015;6(4):411-424. doi: 10.1007/s13300-015-0136-9.
18. 18. Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabetic Medicine. 2018;35(9):1258–1263. doi: 10.1111/dme.13663.
19. 19. Dikeman DT, Westman EC. Carbohydrate-restricted diets and Type 1 diabetes mellitus: Research considerations. Current Opinion in Endocrinology & Diabetes and Obesity. 2021;28(5):437-440. doi: 10.1097/MED.0000000000000669.
20. 20. Seckold R, Howley P, King BR, Bell K, Smith A, Smart CE. Dietary intake and eating patterns of young children with type 1 diabetes achieving glycemic targets. BMJ Open Diabetes Research and Care. 2019;7:1. doi: 10.1136/bmjdrc-2019-000663.
21. 21. Levran N, Levek N, Sher B, et al. The ımpact of a low-carbohydrate diet on micronutrient intake and status in adolescents with type 1 diabetes. Nutrients. 2023;15:1418. doi: 10.3390/nu15061418.
22. 22. Sterner Isaksson S, Ólafsdóttir AF, Lind M. Design of a randomized cross-over study evaluating effects of carbohydrate intake on glycemic control in persons with type 1 diabetes. Front Nutr. 2023;10:1114317. doi: 10.3389/fnut.2023.1114317.
23. 23. Ranjan A, Schmidt S, Damm-Frydenberg C, Holst JJ, Madsbad S, Nørgaard K. Short-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trial. Diabetes Obes Metab. 2017;19(10):1479-1484. doi: 10.1111/dom.12953.
24. 24. Schmidt S, Christensen MB, Serifovski N, et al. Low versus high carbohydrate diet in type 1 diabetes: A 12-week randomized open-label crossover study. Diabetes Obes Metab. 2019;21(7):1680-1688. doi: 10.1111/dom.13725.
25. 25. Krebs JD, Parry Strong A, Cresswell P, Reynolds AN, Hanna A, Haeusler S. A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account. Asia Pac J Clin Nutr. 2016;25(1):78-84. doi: 10.6133/apjcn.20