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How to discuss very low-carbohydrate diets in patients with type 1 diabetes
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Data appearing in Pediatrics earlier this year showed that children and adults seeking long-term treatment for type 1 diabetes who followed a very-low carbohydrate diet had measures of glycemic control in the near-normal range, generally high levels of satisfaction with health and diabetes control, and low rates of hypoglycemia and other adverse events.
“These findings are without precedent among people with type 1 [diabetes], revealing a novel approach to the prevention of long-term diabetes complications,” Belinda S. Lennerz, MD, PhD, of the division of endocrinology at Boston Children’s Hospital and colleagues wrote in Pediatrics.
With CDC data suggesting almost 1 in 10 patients have diabetes or prediabetes, research involving diabetes impacts a large number of patients and has significant implications on the medical community.
Joseph Galati, MD, a Texas-based hepatologist, discussed how primary care physicians can discuss these findings with their patients, and other important takeaways from the study with Healio Family Medicine. – by Janel Miller
Healio: Should PCPs change how they discuss type 1 diabetes with their patients, in light of these findings?
Galati: Old habits are hard to change. In the medical community, change is always difficult, and thinking scientifically, everyone will be asking for “the proof” that this is the right thing to do. Being skeptical is a good thing, especially with patient care and safety; it’s another thing to be so skeptical that it impedes change. It can only be considered a game changer once it is proven and verified through well controlled clinical studies. But no doubt, this study in Pediatrics is an open door to change.
Physicians are fiercely independent individuals, and they have a mindset that they know best, and they are practicing with the patient’s best interest in mind. Of course, this is a commendable position to take, and it is the prerogative of the physician and the patient to have this conversation and understand the pros and cons of any dietary departure from the norm. On one hand, if the patient insists on the adoption of a new dietary approach, and the physician is against it, then this is going to create conflict. Likewise, if the physician recommends a change, and the patient is against it, that too will create tension in the communication and compliance of the patient. It’s always going to come down to transparency and good communication.
Healio: How can PCPs explain the very-low carbohydrate diet approach to patients?
Galati: Because this is somewhat a departure from the typical teachings for patients with type 1 diabetes, it’s going to require additional time on the part of the PCP to carefully explain these new dietary recommendations. Like all new changes, especially one like this that is a rather significant departure from the standard of care, skepticism on the part of the physician and patient needs to be addressed. When approaching the diabetic patient, it does require a multidiscipline approach. This would include the diabetes expert that may be providing care, the primary care physician, diabetic educators, and dietitians. Everyone must be on the same page, considering each one of the members of the care team may be approaching the patient from a slightly different angle and discipline. The patient, or the person doing the shopping and cooking for the patient, needs to understand what foods contain carbohydrates so they know which foods to eliminate.
Healio: What is the take-home message of the Pediatrics study for the medical community?
Galati: This may be an opportunity for researchers and experts in diabetes to revisit the benefits of a low carbohydrate diet in patients with type 1 diabetes. Even though for some this may be a radical departure from the norm, there must be an open mindedness to investigate these findings further. As with any change to established guidelines, I would always recommend proceeding with caution, and if a clinician is going to recommend a low carbohydrate diet, both education and monitoring must be a big part of this change. Further, staff members, who may be the frontline recipients of calls from patients, also need to be in the loop on how this may affect patients and how to appropriately intervene and manage them. PCPs should also remember that patients may not know the difference between observational and randomized trials and may simply go with the bottom line finding that’s been presented in the mainstream media.
Reference: Lennerz BS, et al. Pediatrics. 2018;doi:10.1542/peds.2017-3349.
Disclosure: Galati reports no relevant financial disclosures.