Diet and type 1 diabetes:
A neglected field of research

In many countries the prevalence of type 1 diabetes is increasing. The disease causes blood sugar to rise to levels that increase the risk of cardiovascular disease as well as damaging the kidneys and eyes. Pilot studies have shown that diet can help lower and stabilize blood sugar, but no reliable larger studies have been carried out.

Type 1 diabetes mellitus is one of the most common chronic diseases in childhood, and it is also on the increase among adults. Many people live long lives with the disease, but the high blood sugar it causes can lead to serious damage to the organs of the body. Kidney and eye disease are common and some diabetics develop cardiovascular disease when just middle aged. A study of the Swedish National Diabetes Register – which includes the majority of diabetics in the country – showed that people with type 1 diabetes had more than twice the risk of dying prematurely compared with a control group

Many people have dangerously high blood sugar

In recent years, new insulin treatments have helped many people gain better control over their blood sugar, but many also fail. According to figures from the Swedish National Diabetes Register about a quarter of all people with type 1 diabetes still have a dangerously high average blood glucose (HbA1c). Among other things, this is associated with a five times greater risk of dying from cardiovascular disease..

People who have problems controlling their blood sugar could benefit from a low-GI or a low-carbohydrate diet. A number of small pilot studies show that the quantity and quality of dietary carbohydrates determines how high blood sugar levels rise after a meal. However, these studies are too small to base national treatment guidelines on. When the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) evaluated the scientific basis for dietary advice for type 1 diabetes in 2010, the conclusion was that there was an “obvious lack” of high-quality studies. In the current Swedish dietary advice for diabetics the National Board of Health and Welfare states: “The best diet for diabetes is a topic of intense debate. The area is partly unexplored and the scientific evidence is weak.”

In order to fill this gap in knowledge, the Dietary Science Foundation has supported high-quality study that evaluates how diet can be used to stabilize blood sugar at a low, steady level in type 1 diabetes. The study is conducted at Karolinska University Hospital and fulfills the quality requirements such as those used by Cochrane and the Swedish authority SBU in literature reviews. It will therefore contribute to evidence-based dietary treatment guidelines in the future.

The long-term goal is to strengthen the role of dietary treatments in health care, allowing more people with type 1 diabetes to live longer and healthier lives.

Do you want to help us with this vital work? Make a donation help us in our long-term efforts.

References:

Studies showing that a change of diet can stabilize blood sugar levels in type 1 diabetes:
Rovner, A. J., Nansel, T. R. & Gellar, L. The effect of a low-glycemic diet vs a standard diet on blood glucose levels and macronutrient intake in children with type 1 diabetes. Journal of the American Dietetic Association 109, 303-307, doi:10.1016/j.jada.2008.10.047 (2009).

Buyken, A. E. et al. Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids. The American journal of clinical nutrition 73, 574-581 (2001).

Nielsen, J. V., Gando, C., Joensson, E. & Paulsson, C. Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. Diabetol Metab Syndr 4, 23, doi:10.1186/1758-5996-4-23 (2012).

Studies linking high blood sugar and insulin requirements in type 1 diabetes to high BMI, insulin resistance, and serious complications:

Kilpatrick, E. S., Rigby, A. S. & Atkin, S. L. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the Diabetes Control and Complications Trial. Diabetes care 30, 707-712, doi:10.2337/dc06-1982 (2007).

Soedamah-Muthu, S. S. et al. Predicting major outcomes in type 1 diabetes: a model development and validation study. Diabetologia 57, 2304-2314, doi:10.1007/s00125-014-3358-x (2014).

Thorn, L. M. et al. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes care 28, 2019-2024 (2005).

Thorn, L. M. et al. Metabolic syndrome as a risk factor for cardiovascular disease, mortality, and progression of diabetic nephropathy in type 1 diabetes. Diabetes care 32, 950-952, doi:10.2337/dc08-2022 (2009).
Lind, M. et al. Glycemic control and excess mortality in type 1 diabetes. The New England journal of medicine 371, 1972-1982, doi:10.1056/NEJMoa1408214 (2014).