{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:11:36Z","timestamp":1783566696216,"version":"3.55.0"},"reference-count":9,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Adopting a low\u2010 or very low\u2010carbohydrate (LCD or VLCD) diet in type 1 diabetes mellitus (T1D) is a controversial intervention. The main fear is that these diets may increase the risk of diabetic ketoacidosis. However, there is little data about the ketoacidosis risk and the level of physiological nutritional ketosis in individuals following these diets. We aimed to define the level of ketosis in those with T1D following carbohydrate restricted diets in a real\u2010world observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with T1D who had self\u2010selected dietary carbohydrate restriction were enrolled from local clinics and were compared to those following an unrestricted regular carbohydrate control diet (RCCD). Participants completed a 3\u2010day diary, documenting food intake, ketones, and blood\/interstitial glucose concentrations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants were divided into three groups according to mean carbohydrate intake: VLCD (&lt;50\u2009g carbohydrates\/day) <jats:italic>n<\/jats:italic>\u2009=\u20096, LCD (50\u2013130\u2009g carbohydrates\/day) <jats:italic>n<\/jats:italic>\u2009=\u20096, and RCCD (&gt;130\u2009g carbohydrates\/day) <jats:italic>n<\/jats:italic>\u2009=\u20093. Mean beta\u2010hydroxybutyrate (BOHB) concentrations were 1.2\u2009mmol\/l (SD 0.14), 0.3\u2009mmol\/l (SD 0.12) and 0.1mmol\/l (SD 0.05) in the VLCD, LCD and RCCD groups, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). Post hoc Dunn test demonstrated this reached statistical significance between the VLCD and RCCD groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Carbohydrate restricted diets, in particular VLCDs, are associated with a higher BOHB level. However, the degree of ketosis seen is much lower than we expected, and significantly lower than the level typically associated with diabetic ketoacidosis. This may suggest the risk of ketoacidosis is lower than feared, although safety will need to be evaluated further in large scale randomised trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.15178","type":"journal-article","created":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T14:48:32Z","timestamp":1689518912000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Type 1 diabetes and low carbohydrate diets\u2014Defining the degree of nutritional ketosis"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9316-0377","authenticated-orcid":false,"given":"Hakan","family":"Ozoran","sequence":"first","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9636-1286","authenticated-orcid":false,"given":"Michael","family":"Matheou","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism Oxford University Hospitals Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5391-6301","authenticated-orcid":false,"given":"Pam","family":"Dyson","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2751-1770","authenticated-orcid":false,"given":"Fredrik","family":"Karpe","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism University of Oxford  Oxford UK"},{"name":"NIHR Biomedical Research Centre Oxford University Hospitals Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garry D.","family":"Tan","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism Oxford University Hospitals Foundation Trust  Oxford UK"},{"name":"NIHR Biomedical Research Centre Oxford University Hospitals Foundation Trust  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,26]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Lower carbohydrate diets for adults with type 2 diabetes Scientific Advisory Committee On nutrition Diabetes UK.2021Available from:https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/1014673\/SACN_report_on_lower_carbohydrate_diets_for_type_2_diabetes.pdf. Accessed 28 February 2022"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI142246"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3349"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02543.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.6133\/apjcn.2016.25.1.11"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12953"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/db19-72-LB"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13725"},{"key":"e_1_2_6_10_1","unstructured":"National Diabetes Audit 2019\u20102020 Type 1 Diabetes.2021https:\/\/digital.nhs.uk\/data\u2010and\u2010information\/publications\/statistical\/national\u2010diabetes\u2010audit\/national\u2010diabetes\u2010audit\u20102019\u201020\u2010type\u20101\u2010diabetes. Accessed 28 February 2022"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dme.15178","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T06:17:04Z","timestamp":1694845024000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dme.15178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,26]]},"references-count":9,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1111\/dme.15178"],"URL":"https:\/\/doi.org\/10.1111\/dme.15178","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,26]]},"assertion":[{"value":"2023-05-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e15178"}}