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Position Statement - therapeutic carbohydrate reduction for type 1 diabetes - Society of Metabolic Health Practitioners (doi.org)

submitted 2 weeks ago by [email protected] to c/[email protected]

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This article presents the position of the Society of Metabolic Health Practitioners (SMHP) regarding therapeutic carbohydrate reduction (TCR) nutrition interventions for type 1 diabetes mellitus (T1DM). A modified Delphi methodology was used to arrive at a consensus consisting of several focus groups, multiple rounds, and an anonymous survey. The field of endocrinology has seen many new advances for the treatment of T1DM including hybrid closed-loop insulin delivery systems and continuous glucose monitors for better glycaemic control, monoclonal antibodies to delay the onset of disease and increased access to paediatric endocrinologists, among many other noteworthy achievements. Despite these advancements, standard of care approaches to T1DM result in higher than acceptable morbidity and mortality, with a high prevalence of microvascular and macrovascular complications. Insulin resistance in type 1 diabetes is an independent risk factor for adverse outcomes even in well controlled type 1 diabetes. In 2021, only 21% of adults with T1DM in the United States achieved the American Diabetes Association’s (ADA’s) target haemoglobin A1C goal of < 7.0%, while data in the paediatric and adolescent population have demonstrated worse glycaemic control. Supported by observational and interventional evidence, the SMHP advocates for the reevaluation of the prevailing nutritional therapy for T1DM with more broad consideration for TCR. The SMHP recommends open access and clinical support for TCR nutrition interventions for individuals with T1DM of all ages and calls upon the medical community to help foster more attention and research on TCR for T1DM.

In conclusion, this consensus statement conducted by the SMHP advocates for open access and clinical support for TCR nutrition interventions for individuals with T1DM across all age groups. As a component of diabetes-focused MNT, TCR nutrition therapy exhibits promising results supported by emerging evidence. It is imperative that individuals diagnosed with T1DM, along with their families, receive comprehensive information, education, and support from their entire healthcare team regarding the option of TCR nutrition interventions. This proactive approach ensures that every patient can make well- informed decisions about the nutrition component of their treatment plan, with TCR being presented as a viable therapeutic option from the outset of diagnosis

Position statements from medical organizations are a good view of changing zeitgeists, and are good references for those in practice. The fact that Total Carbohydrate restriction is a useful option for those treating T1D is documented here.

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[–] [email protected] 1 points 2 weeks ago* (last edited 2 weeks ago)

Notes:

Insulin resistance in type 1 diabetes is an independent risk factor for adverse outcomes even in well controlled type 1 diabetes.

In 2021, only 21% of adults with T1DM in the United States achieved the American Diabetes Association’s (ADA’s) target haemoglobin A1C goal of < 7.0%, while data in the paediatric and adolescent population have demonstrated worse glycaemic control.

In the US, roughly 65% of patients with T1DM will transition to an insulin pump for the management of glycaemia

cardiovascular disease, already the leading cause of death in patients without T1DM, is more prevalent among those with T1DM

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. The inclusion of these dietary paradigms by the ADA implies counting carbohydrates and insulin bolusing is optimal when there are no randomised interventional trials showing this is the optimal approach

A 2014 meta-analysis found that standard carbohydrate counting led to only a marginal haemoglobin A1C reduction of 0.3%, equating to an average blood glucose improvement of 10 mg/dL

For context, the difference between normal blood glucose levels and the average blood glucose level attained by a child with T1DM using carbohydrate counting is approximately 100 mg/dL

i.e. there is still 90mg/dL elevation, which isn't great.

Another somewhat under-recognised but vitally important complication of high glycaemic eating and the resulting higher insulin doses is a condition called ‘double diabetes’. This is a condition where insulin resistance and its sequelae of obesity and cardiometabolic complications occur. The prevalence is now around 25% in patients with T1DM,24 and is trending upward

Patients with T1DM experience comorbid major depression and depressive symptoms at a rate of 11% and 31%, respectively. Psychological issues and, separately, diminished quality of life have both been linked with suboptimal glycaemic control and diabetes complications

MNT is quite confusing where most approaches still recommend starches, grains, legumes, and high-sugar fruit, which is antithetical to their recommendations to reduce overall carbohydrate and sugar intake.