Consensus Statements

The SMHP™ position statement on therapeutic carbohydrate reduction for type 1 diabetes

Tro Kalayjian, Beth J. McNally, Matthew W. Calkins, Mark T. Cucuzzella, Robert Cywes, Hayden Dikeman, David T. Dikeman, Evelyne Bourdua-Roy, Sarah M. Rice, Ian Lake, Laura A. Buchanan, Douglas B. Reynolds, Mirian Kalamian, Eric C. Westman
Journal of Metabolic Health | Vol 7, No 1 | a100 | DOI: https://doi.org/10.4102/jmh.v7i1.100 | © 2024 Tro Kalayjian, Beth J. McNally, Matthew W. Calkins, Mark T. Cucuzzella, Robert Cywes, Hayden Dikeman, David T. Dikeman, Evelyne Bourdua-Roy, Sarah M. Rice, Ian Lake, Laura A. Buchanan, Douglas B. Reynolds, Mirian Kalamian, Eric C. Westman | This work is licensed under CC Attribution 4.0
Submitted: 17 August 2024 | Published: 30 November 2024

About the author(s)

Tro Kalayjian, Department of Medicine, Greenwich Hospital/Yale New Haven Health, Greenwich, Connecticut, United States
Beth J. McNally, Private Practice Nutritionist, Kingston, Ontario, Canada
Matthew W. Calkins, Department of Family Medicine, Atrium One Health, Rural Hall, United States
Mark T. Cucuzzella, Department of Family Medicine, West Virginia University, Morgantown, West Virginia, United States
Robert Cywes, Private Practice Doctor, Jupiter, Florida, United States
Hayden Dikeman, Department of Biology, Emory University, Atlanta, Georgia, United States
David T. Dikeman, Department of Biology, Baylor University, Waco, Texas, United States
Evelyne Bourdua-Roy, Private Practice Doctor, Quebec, Canada
Sarah M. Rice, Private Research and editing, Cape Town,, South Africa
Ian Lake, Private Practice Doctor, Gloucester, United Kingdom
Laura A. Buchanan, Department of Telemedicine, Toward Health, Tappan, New York State, United States
Douglas B. Reynolds, Society of Metabolic Health Practitioners, San Diego, California, United States
Mirian Kalamian, Private Practice Nutritionist, Hamilton, Montana, United States
Eric C. Westman, Department of Medicine, Duke University Health System, Durham, North Carolina, United States

Abstract

This article presents the position of the Society of Metabolic Health Practitioners (SMHP) regarding therapeutic carbohydrate reduction (TCR) nutrition interventions for type 1 diabetes mellitus (T1DM). A modified Delphi methodology was used to arrive at a consensus consisting of several focus groups, multiple rounds, and an anonymous survey. The field of endocrinology has seen many new advances for the treatment of T1DM including hybrid closed-loop insulin delivery systems and continuous glucose monitors for better glycaemic control, monoclonal antibodies to delay the onset of disease and increased access to paediatric endocrinologists, among many other noteworthy achievements. Despite these advancements, standard of care approaches to T1DM result in higher than acceptable morbidity and mortality, with a high prevalence of microvascular and macrovascular complications. Insulin resistance in type 1 diabetes is an independent risk factor for adverse outcomes even in well controlled type 1 diabetes. In 2021, only 21% of adults with T1DM in the United States achieved the American Diabetes Association’s (ADA’s) target haemoglobin A1C goal of < 7.0%, while data in the paediatric and adolescent population have demonstrated worse glycaemic control. Supported by observational and interventional evidence, the SMHP advocates for the reevaluation of the prevailing nutritional therapy for T1DM with more broad consideration for TCR. The SMHP recommends open access and clinical support for TCR nutrition interventions for individuals with T1DM of all ages and calls upon the medical community to help foster more attention and research on TCR for T1DM.


Keywords

Type 1 diabetes mellitus; therapeutic carbohydrate reduction; low-carbohydrate diet; ketogenic diet; very low-carbohydrate diet; glycaemic control; double diabetes; insulin resistance.

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