{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T03:56:08Z","timestamp":1778126168095,"version":"3.51.4"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Diet is an important factor in managing glycemic control in type 1 diabetes (T1D). Reducing carbohydrate intake may be important for stabilizing blood glucose levels in certain groups of patients with T1D. There are few studies examining the effects of a low carbohydrate diet in patients with T1D. The aim of this study is to investigate the effects of carbohydrate intake on glucose control in adults with T1D.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Adults with T1D (<jats:italic>N<\/jats:italic>\u2009=\u200954) and inadequate glycemic control (HbA1c\u2009\u2265\u20097.5%; 58\u2009mmol\/mol) were randomized in a cross-over design to a moderate carbohydrate diet (30 percent of total energy from carbohydrates) versus a traditional diabetes diet (50 percent of total energy from carbohydrates) for 4\u2009weeks with a between wash-out period of 4\u2009weeks. Masked continuous glucose monitoring was used throughout the study to evaluate effects on mean blood glucose levels, time-in-range, hypoglycemia, hyperglycemia, and glycemic variability. Diabetes treatment satisfaction, hypoglycemic confidence, and physical activity were measured using questionnaires during different phases of the trial. HbA1c, blood lipids, blood pressure, and ketone levels were also measured. The primary endpoint is the difference in mean blood glucose level between the diet periods. Study completion is anticipated during winter 2022.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The study seeks to increase knowledge about the effects of dietary carbohydrate intake on glycemic control and other health parameters in patients with T1D. If beneficial effects on mean blood glucose level without elevated risk of hypoglycemia or ketoacidosis are shown, a moderate carbohydrate diet may be a treatment option for people with T1D that have unsatisfactory blood glucose levels.<\/jats:p><jats:p><jats:bold>Clinical Trials Registration:<\/jats:bold><jats:ext-link>www.clinicaltrials.gov<\/jats:ext-link>, ID: NCT03400618.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2023.1114317","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T11:47:17Z","timestamp":1678708037000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Design of a randomized cross-over study evaluating effects of carbohydrate intake on glycemic control in persons with type 1 diabetes"],"prefix":"10.3389","volume":"10","author":[{"given":"Sofia","family":"Sterner Isaksson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnd\u00eds F.","family":"\u00d3lafsd\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Lind","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1056\/NEJM199309303291401","article-title":"The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus","volume":"329","year":"1993","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2643","DOI":"10.1056\/NEJMoa052187","article-title":"(diabetes control and complications trial\/epidemiology of diabetes interventions and complications (DCCT\/EDIC) study research group.) intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes","volume":"353","author":"Nathan","year":"2005","journal-title":"N Engl J Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1056\/NEJMoa1408214","article-title":"Glycemic control and excess mortality in type 1 diabetes","volume":"371","author":"Lind","year":"2014","journal-title":"N Engl J Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1177\/1932296816652901","article-title":"Glycemic control, renal complications, and current smoking in relation to excess risk of mortality in persons with type 1 diabetes","volume":"10","author":"Ahl\u00e9n","year":"2016","journal-title":"J Diabetes Sci Technol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"731","DOI":"10.2337\/dci19-0014","article-title":"Nutrition therapy for adults with diabetes or prediabetes: a consensus report","volume":"42","author":"Evert","year":"2019","journal-title":"Diabetes Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1111\/dme.13603","article-title":"Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes","volume":"35","author":"Dyson","year":"2018","journal-title":"Diabet Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1093\/jn\/138.4.775","article-title":"Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population","volume":"138","author":"N\u00f6thlings","year":"2008","journal-title":"J Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1852","DOI":"10.1161\/01.CIR.0000062644.42133.5F","article-title":"Fish and long-chain \u03c9-3 fatty acid intake and risk of coronary heart disease and Total mortality in diabetic women","volume":"107","author":"Hu","year":"2003","journal-title":"Circulation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1161\/CIRCULATIONAHA.109.907360","article-title":"Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease\u2013specific mortality among women with type 2 diabetes mellitus","volume":"121","author":"He","year":"2010","journal-title":"Circulation"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e1003053","DOI":"10.1371\/journal.pmed.1003053","article-title":"Dietary fibre and whole grains in diabetes management: systematic review and meta-analyses","volume":"17","author":"Reynolds","year":"2020","journal-title":"PLoS Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1017\/S0007114510001546","article-title":"Nuts, metabolic syndrome and diabetes","volume":"104","author":"Kendall","year":"2010","journal-title":"Br J Nutr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1056\/NEJMoa1800389","article-title":"Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts","volume":"378","author":"Estruch","year":"2018","journal-title":"N Engl J Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1007\/s10654-019-00534-1","article-title":"Impact of different dietary approaches on blood lipid control in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis","volume":"34","author":"Neuenschwander","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e001971","DOI":"10.1136\/bmjdrc-2020-001971","article-title":"Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial","volume":"9","author":"Sterner Isaksson","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/S2213-8587(13)70144-X","article-title":"Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis","volume":"2","author":"Bell","year":"2014","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.2337\/diacare.24.7.1137","article-title":"The effect of flexible low glycemic index dietary advice versus measured carbohydrate exchange diets on glycemic control in children with type 1 diabetes","volume":"24","author":"Gilbertson","year":"2001","journal-title":"Diabetes Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1111\/dme.13984","article-title":"Assessment of Alimentaci\u00f3n normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with type 1 diabetes: a randomized controlled parallel trial","volume":"36","author":"S\u00e1nchez-Hern\u00e1ndez","year":"2019","journal-title":"Diabet Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/dom.12087","article-title":"Variability of glucose-lowering effect as a limiting factor in optimizing basal insulin therapy: a review","volume":"15","author":"Vora","year":"2013","journal-title":"Diabetes Obes Metab"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/1205121","article-title":"Factors affecting the absorption of subcutaneously administered insulin: effect on variability","volume":"2018","author":"Gradel","year":"2018","journal-title":"J Diabetes Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1097\/MCO.0000000000000185","article-title":"Exercise-associated glucose metabolism in individuals with type 1 diabetes mellitus","volume":"18","author":"Bally","year":"2015","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0194987","DOI":"10.1371\/journal.pone.0194987","article-title":"Low-carbohydrate diets for type 1 diabetes mellitus: a systematic review","volume":"13","author":"Turton","year":"2018","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1046\/j.1464-5491.2000.00283.x","article-title":"Carbohydrate sources and glycaemic control in type 1 diabetes mellitus. EURODIAB IDDM complications study group","volume":"17","author":"Buyken","year":"2000","journal-title":"Diabet Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/s12937-020-00645-6","article-title":"The quality of dietary carbohydrate and fat is associated with better metabolic control in persons with type 1 and type 2 diabetes","volume":"19","author":"Jacobsen","year":"2020","journal-title":"Nutr J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"107818","DOI":"10.1016\/j.diabres.2019.107818","article-title":"Dietary carbohydrate intake and cardio-metabolic risk factors in type 1 diabetes","volume":"155","author":"Ahola","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1111\/dme.13663","article-title":"The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia","volume":"35","author":"Leow","year":"2018","journal-title":"Diabet Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"78","DOI":"10.6133\/apjcn.2016.25.1.11","article-title":"A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account","volume":"25","author":"Krebs","year":"2016","journal-title":"Asia Pac J Clin Nutr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1111\/dom.12953","article-title":"Short-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trial","volume":"19","author":"Ranjan","year":"2017","journal-title":"Diabetes Obes Metab"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1111\/dom.13725","article-title":"Low versus high carbohydrate diet in type 1 diabetes: A 12-week randomized open-label crossover study","volume":"21","author":"Schmidt","year":"2019","journal-title":"Diabetes Obes Metab"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1758-5996-4-23","article-title":"Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit","volume":"4","author":"Nielsen","year":"2012","journal-title":"Diabetol Metab Syndr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1089\/1540419031361345","article-title":"The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus","volume":"1","author":"O' Neill","year":"2003","journal-title":"Metab Syndr Relat Disord"},{"key":"ref31","article-title":"The diabetes treatment satisfaction questionnaire: DTSQ","volume-title":"Handbook of psychology and diabetes: A guide to psychological measurement in diabetes research and practice","author":"Bradley","year":"1994"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"530","DOI":"10.2337\/diacare.22.3.530","article-title":"Diabetes treatment satisfaction questionnaire. Change version for use alongside status version provides appropriate solution where ceiling effects occur","volume":"22","author":"Bradley","year":"1999","journal-title":"Diabetes Care"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1089\/dia.2016.0366","article-title":"Investigating hypoglycemic confidence in type 1 and type 2 diabetes","volume":"19","author":"Polonsky","year":"2017","journal-title":"Diabetes Technol Ther"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1001\/jama.2016.19976","article-title":"Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial","volume":"317","author":"Lind","year":"2017","journal-title":"JAMA"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1079\/PHN2002409","article-title":"Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European prospective investigation into cancer and nutrition (EPIC)","volume":"5","author":"Ferrari","year":"2002","journal-title":"Public Health Nutr"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/aje\/kwg092","article-title":"Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study","volume":"158","author":"Subar","year":"2003","journal-title":"Am J Epidemiol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1114317\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T11:47:23Z","timestamp":1678708043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2023.1114317\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,13]]},"references-count":36,"alternative-id":["10.3389\/fnut.2023.1114317"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2023.1114317","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,13]]},"article-number":"1114317"}}