Over 2 million people in the U.S. are living with type 1 diabetes (T1D). Despite advancements in care, only 21% are estimated to have an A1C below the target level of 7. Clearly, there’s an urgent need for more effective treatment options.
Transcript:
Low Carb Should Be An Option For Type 1 Diabetes
I remember when I started using ketogenic diets as a therapeutic intervention to treat my patients, there was one group of patients, I didn’t want to go near with carbohydrate reduction, and that was those with type 1 diabetes. I saw them as the so called third-rail, right? Don’t touch it. The risk was too high, it was far too complicated. Looking back, I was clearly naive and uneducated. Now I think people with type 1 diabetes could have the most to gain from using ketogenic therapy and therapeutic carbohydrate reduction. It’s an intervention that can improve the lives of countless adults and adolescents living with type 1 diabetes. And we now have the first paper, the first published expert consensus paper on therapeutic carbohydrate reduction in type 1 diabetes. Let’s talk about it. Welcome to Metabolic Mind, a non-profit initiative of Baszucki Group, transforming the study and treatment of mental disorders by exploring the connection between metabolism and brain health. Thank you for joining us on this journey.
Keto & T1D Disclaimer
As usual, before we get into the details, please remember our channel is for informational purposes only. We’re not providing medical advice for establishing a provider-patient relationship. Ketogenic diets in type 1 diabetes can be very dangerous if done without proper clinical supervision. So always check with your healthcare provider before changing your lifestyle or your medications. So as I said, initially there was no way I would use a ketogenic diet in an individual with type 1 diabetes. And now I think it could be the most valuable therapy available. But it took time, it took education and conversations with the experts with experience. And eventually I was comfortable enough to incorporate it into my practice. But what’s the average endocrinologist or primary care doctor to do? How do they get access to the experts to learn how to do this?
New Paper Published in Journal of Metabolic Health
Well now we just got one step closer with a publication in the Journal of Metabolic Health. That’s a position statement on therapeutic carbohydrate reduction for type 1 diabetes. This has the potential to help thousands of individuals achieve better glycemic control, with fewer complications, which should be the goal, right?
Current State of Type 1 Diabetes Management in U.S.
But first let’s set the stage. The publication in the beginning acknowledges that there have been significant advancements in the standard of care for individuals with type 1 diabetes. There’s closed-loop insulin delivery systems and of course, continuous glucose monitors. There’s even monoclonal antibody therapy, and increased access to more medical care and other advances. But despite all that, a study showing in 2021, only 21% of adults with type 1 diabetes in the United States achieved the target hemoglobin A1c of less than 7. That’s less than 7, that’s nowhere near normal. But that’s kind of what’s felt to be safe for people with type 1 diabetes and is therefore the goal. And still less than a quarter of individuals even met that goal. And for the pediatric and adolescent population, the numbers are even worse. So it’s clear something better needs to be done, something needs to be done to prevent the eventual development of vascular complications or the risk of hypoglycemic emergencies that come with having type 1 diabetes.
Expert Conclusions
So the team at the Society for Metabolic Health Practitioners, embarked on a modified Delphi process. So for those who aren’t familiar with it, a Delphi is a pretty cool process where I guess you can say when there isn’t a tremendous amount of literature and studies to derive treatment guidelines, it’s a process where you get the experts in the field together and you develop a series of different statements and see how many of those experts agree or disagree with the statements. Based on that, combined with the research that does exist at the time, you publish a consensus statement about what the experts agree or disagree on at the time. It always could change, but at this moment, this is what the experts agree on. And there are conclusions in this case were noteworthy. First and foremost, the experts concluded that the standard of care is suboptimal and needs to change. I think we established that, right? They also concluded that therapeutic carbohydrate reduction is safe and effective for improving glycemic control in individuals with type 1 diabetes. They concluded there is not an increased risk of ketoacidosis, there is not an increased risk of hypoglycemia, and there is a definite improvement in glycemic control.
Future of Type 1 Diabetes Care
Now the key of course is doing it appropriately with careful monitoring and appropriate intervention and with expert guidance. And a Delphi process like this won’t tell us all the details of how to do that, but it’s the first step in getting there. This published expert statement should alert everyone in healthcare to the fact that this is an option. It’s agreed upon by experts and should spur more research into carbohydrate reduction for type 1 diabetes and more training for clinicians and resources for patients and families with eventual broader adoption of therapeutic carbohydrate reduction. If this existed when I was starting with my practice, I bet my transition to using it in patients with type 1 diabetes would have been much faster. This paper gives encouragement. I hope we can all envision a future where everyone with type 1 diabetes has a normal hemoglobin A1c, not just 7.0, but normal.
So I send out a huge thank you to the authors of the paper, and now the job is getting it out there so it’s seen by more clinicians, more researchers, more patients and families, and patient advocates. So if you want to learn more about carbohydrate reduction in type 1 diabetes, you can watch our interview with Dr. Andrew Koutnik, who’s not just a diabetes researcher, but also lives with type 1 diabetes, and he’s a shining example of how someone can safely achieve completely normal blood sugar control with carbohydrate reduction. Thank you for watching, I’m Dr. Bret Scher, and we’ll see you here next time at Metabolic Mind, a non-profit initiative of Baszucki Group.
