P-318: Very-low-carbohydrate diets in children with type 1 diabetes: a DPV registry analysis
C Denzer, A Eckert, E Fröhlich-Reiterer, T Kapellen, S Lanzinger, B LennerzAbstract
Introduction
Very-low-carbohydrate (VLC) diets are increasingly adopted by families of children with type 1 diabetes (T1D) to improve glycemic control, yet concerns remain regarding growth and metabolic safety. Evidence largely derives from short-term observation studies.
Objectives
We evaluated associations of dietary carbohydrate intake with growth, glycemic outcomes, insulin requirements, and acute complications using the diabetes prospective follow-up registry (DPV).
Methods
Youth aged 1-<18 years with T1D, diabetes duration ≥3 months, without celiac disease or eating disorder, and ≥2 diet-consistent carbohydrate records over ≥1 year between 2000-2025 were categorized by carbohydrate percentage of energy intake: VLC (<10%), low carbohydrate (LC, 10-<26%), standard carbohydrate (SC, ≥26%). Linear regression and negative binomial models were used, adjusting for sex, age, migration background, year, diabetes and diet duration, and technology use. Analyses of longitudinal growth were limited to girls <14, boys <16 yrs.
Results
We included 45,569 youth with T1D. Height-SDS showed minimal changes, with no clinically meaningful VLC-specific growth attenuation. BMI-SDS increased less in VLC and LC than SC. Diet-end HbA1c, basal insulin needs, and notably IDAA1c were lower in VLC and LC, with attenuated increases over time. Adjusted LS-means (95% CI) are tabulated. Severe hypoglycemia and ketoacidosis (DKA) rates were low and did not differ by diet.
Conclusions
This is the largest published group of children with T1D following a VLC diet. Addressing key safety concerns, VLC intake was not associated with impaired linear growth, DKA, or severe hypoglycemia over 1-5 years. Lower carbohydrate intake was associated with favorable changes in BMI, glycemia, and insulin needs. These findings support prospective evaluation of carbohydrate reduction in pediatric T1D. Residual confounding by self-reported diet, baseline differences, diet duration, and selection bias cannot be excluded.