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Can a ketogenic diet be safely used to improve glycaemic control in a child with type 1 diabetes?
  1. Anne-Marie McClean,
  2. Luca Montorio,
  3. Diarmuid McLaughlin,
  4. Shelia McGovern,
  5. Nuala Flanagan
  1. Paediatric Department, The Ulster Hospital, Dundonald, Belfast, UK
  1. Correspondence to Dr Anne-Marie McClean, Paediatric Department, The Ulster Hospital, Dundonald, Belfast BT16 1RH, UK; mccleanam{at}gmail.com

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Scenario

A 5-year-old boy with known type 1 diabetes mellitus (T1DM), treated with insulin, presents to the paediatric diabetes outpatient department for his routine clinic review. The family have started the boy on a ketogenic diet (<50 g of carbohydrates daily with target blood ketones of 2–3 mmol/L) to improve his diabetes control and for additional perceived health benefits. On the ketogenic diet, the patient’s insulin needs decreased, his HbA1c is good (41mmol/L/5.2%) and his height and weight are increasing along the 75th centile for his age. He has normal screening bloods (including lipids) and a normal ECG.

The paediatric diabetes multidisciplinary team traditionally recommend a low-fat, high-carbohydrate diet for children with T1DM. The team have no experience of using a ketogenic or low-carbohydrate diet for the management of T1DM in children treated with insulin. You wonder if there is evidence to support the ketogenic diet in children with T1DM and if there are potential risks associated with the low-carbohydrate diet.

Structured clinical question

In children with type 1 diabetes mellitus treated with insulin (population), is a ketogenic diet (intervention) effective in improving glycaemic control or do the risks outweigh any potential benefits (outcomes)?

Search

Primary sources

The search was conducted independently by four reviewers. An advanced search of the electronic databases Medline (1946 to present) and PubMed Central using the search strings: (paediatric OR pediatric OR child OR infant) AND (Diabetes Mellitus OR T1DM OR Type 1 Diabetes Mellitus OR Type One Diabetes Mellitus) AND (ketogenic diet) and mapped to subject headings. The search was repeated excluding age restrictions to ensure capture of all relevant articles.

The initial search identified six articles. With limited results regarding the ketogenic diet the authors extended the search. The search strings were expanded to ‘AND (ketogenic diet OR low carbohydrate diet)’ to ensure patients with T1DM on low or restricted carbohydrate diets …

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