Efeitos da dieta de baixo carboidrato no tratamento de pacientes adultos com diabetes Mellitus tipo 1.

Abstract

Type 1 diabetes Mellitus (DM1) is an autoimmune disease characterized by the destruction of pancreatic beta cells and absolute insulin deficiency. As a result, glucose stays in the blood instead of being used as an energy source. Food macronutrients, mainly carbohydrates, are responsible for blood fluctuations in patients with DM1. Despite this, health guidelines do not recognize a low carbohydrate diet as an alternative for the treatment of patients with DM1, and recommend the consumption of approximately 50% - 60% of daily calories in the form of carbohydrates. With this, we developed a detailed protocol model to evaluate the effects of a low carbohydrate diet in the treatment of adult patients with DM1. For this, 12 patients aged 21 to 50 years old, diagnosed with DM1, with a glycated hemoglobin ≥7.0% and within the previously defined inclusion and exclusion criteria, were recruited. The patients were submitted to three phases of the diet during the study: phase 1: 130g of carbohydrates/day (15 days), 90g of carbohydrates/day (7 days) and finally, 50g of carbohydrates/day until completing the sixth month of treatment. Laboratory tests were performed at three moments: before the start of treatment, at three and six months. Our findings indicated a clinically significant reduction in glycated hemoglobin (Hb1Ac), the gold standard for analyzing diabetes control, from before the start of treatment to the third month, persisting until the sixth month. Concomitantly, with the significant reduction in Hb1Ac, the patients showed a significant increase in the percentage of time on target (70 mg/dL – 180 mg/dL) and a reduction in the percentage of hypoglycemia (< 70mg/dL) and hyperglycemia (> 180mg/dL). In addition, lipid, liver, kidney and thyroid function were evaluated, as well as cardiovascular risk markers, which were not affected by this approach, indicating that the protocol is safe. Therefore, our findings indicate that a nutritionally dense, low-carbohydrate diet, along with the carbohydrate, protein, and fat counting approach proposed in the study, is easy, feasible, and may be a safe and effective alternative for T1DM patients. This approach provides better glycemic control and less glycemic variability, being a very interesting protocol for larger and multicenter randomized clinical trials.