The DOI matches its Crossref record; 14 of the 14 references it cites were found in a registry or an index.
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
Abstract
Aims: To investigate whether very‐low‐carbohydrate high‐fat diets, typical of ketogenic diets, can improve glycaemic control without causing any ill health effects in adults with Type 1 diabetes. Methods: In this observational study, 11 adults with Type 1 diabetes (seven men, four women, mean ± sd age 36.1± 6.8 years, mean ± sd duration of diabetes 12.8 ± 10.3 years), who followed a ketogenic diet (< 55 g carbohydrate per day) for a mean ± sd of 2.6 ± 3.3 years (β‐hydroxybutyrate 1.6 ± 1.3 mmol/l), underwent sampling and analysis of fasting blood, and were fitted with a blinded continuous glucose monitor for 7 days to measure glycaemic variability. Results: The mean ± sd HbA 1c levels were 35±4 mmol/mol (5.3±0.4%), and participants spent 74±20 and 3±8% of their time in the euglycaemic (4–8 mmol/l) and hyperglycaemic (>10 mmol/l) ranges, respectively, with little daily glycaemic variability (sd 1.5±0.7 mmol/l; coefficient of variation 26±8%). Blood glucose levels were <3.0 mmol/l for 3.6% of the time, and participants experienced a median (range) of 0.9 (0.0–2.0) daily episodes of hypoglycaemia. Total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, and triglycerides were above the recommended range in 82%, 82%, 64% and 27% of participants, respectively; however, HDL cholesterol levels were within the recommended range for all participants. Participants displayed no or little evidence of hepatic or renal dysfunction. Conclusion: This study provides the first evidence that, ketogenic diets in adults with Type 1 diabetes are associated with excellent HbA 1c levels and little glycaemic variability, but may also be associated with dyslipidaemia and a high number of hypoglycaemic episodes.
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“However, its effects on lipid parameters remain contentious. Some studies report positive improvements, while others observe increases in lipid profiles [8, 9].”
From Ketogenic diet-induced changes in adult lipid metabolism: a comprehensive systematic review and meta-regression of randomized controlled trials (2026) · cites this paper as [8]
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“Hypoglycaemia is possible if hypoglycaemic drugs are also taken [74].”
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Frier, B. M. (2014) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2014.170 · Cited by 491
Effect on Blood Lipids of Very High Intakes of Fiber in Diets Low in Saturated Fat and Cholesterol
Jenkins, D., Wolever, T. M. S., Rao, A. V., Hegele, R. A., Mitchell, S. J., Ransom, T. P. P., Boctor, D. L., Spadafora, P. J., Jenkins, A. L., Mehling, C. C., et al. (1993) · New England Journal of Medicine · doi:10.1056/nejm199307013290104 · Cited by 301
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High-fat diet causes iron deficiency via hepcidin-independent reduction of duodenal iron absorption
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Effects of advanced carbohydrate counting in patients with Type 1 diabetes: a systematic review
Schmidt, S., Schelde, B., & Nørgaard, K. (2014) · Diabetic Medicine · doi:10.1111/dme.12446 · Cited by 94
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Ketogenic Diet and Glucose Control
Lee, Y. H. (2019) · Journal of Korean Diabetes · doi:10.4093/jkd.2019.20.4.244
McAlister, A., Green, V., Camel, S. P., & Fontenot, C. (2020) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2020.04.139
Special diet in type 1 diabetes: do gender and BMI-SDS differ?
Thiele, A. G., Prinz, N., Flury, M., Hess, M., Klose, D., Meißner, T., Raile, K., Weis, I., Wenzel, S., Tittel, S. R., et al. (2021) · Child and Adolescent Obesity · doi:10.1080/2574254x.2021.2002061
Restriction en glucides, diète cétogène et diabète de type 1
Andréelli, F. (2022) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2022.09.004
POTENTIAL EFFECTS OF KETOGENIC DIETS, A NARRATIVE REVIEW
Stoizik, J. A. M., Avena, M. V., Elías, M. L., HEREDIA, R., & Boarelli, P. V. (2023) · SOUTHERN JOURNAL OF SCIENCES · doi:10.48141/sjs.v31.n36.2023_mussi_stoizik_pgs_20_32.pdf
Ketogenic Diet for Type I Diabetes Mellitus. Literature Review and Clinical Experience
Generalov, V. O., Obodzinskaya, I. E., Русланович, С. Т., Prikazchikov, S. V., & Aleksandrenkova, A. A. (2024) · City Healthcare · doi:10.47619/2713-2617.zm.2024.v.5i2;16-23
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Tosefsky, K. N., Lam, J. S. T., Wang, Y. N., Keymanesh, S., Kuan, A. J., Metcalfe‐Roach, A., Cirstea, M. S., Sacheli, M., Finlay, B. B., Cohen, T. R., et al. (2025) · medRxiv · doi:10.1101/2025.04.01.25325057
What Should be the Ideal Carbohydrate Intake in Type 1 Diabetes?: A Literature Review
Baştürk, B., & Özkaya, V. (2025) · İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi · doi:10.38079/igusabder.1377178
Effect of Ketogenic Diet on Selected Cardiometabolic-Related Diseases
Ogbonnaya, F. C., & Shokunbi, O. S. (2025) · Baghdad Journal of Biochemistry and Applied Biological Sciences · doi:10.47419/bjbabs.v6i02.287
The skinny on ‘keto’: the low-carb, high-fat diet everyone is talking about
Ch’ng, W. X. M., & Ng, M. C. W. (2025) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2022-146
The application of low-carb diet in diabetes treatment
Yuchen, H., & Yin, J. (2025) · Scientia Sinica Vitae · doi:10.1360/ssv-2025-0020
Albaladejo, L., Ferguene, M., Genoux, B., Marchand, L., Boullay, H. D., Lablanche, S., Vermorel, C., Gauchet, A., Bosson, J., & Betry, C. (2026) · Diabetes & Metabolism · doi:10.1016/j.diabet.2026.101735
Isaksson, S. S., Imberg, H., Ólafsdóttir, A. F., Ivarsson, S., Toft, E., Hallström, S., Rosenqvist, U., Ekström, M., & Lind, M. (2026) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2025-001410
Nutritional strategies in kidney transplantation: optimising outcomes beyond surgery
Caldiroli, L., Molinari, P., Vettoretti, S., Regalia, A. L., Verdesca, S., Castellano, G., Gallieni, M. A., & Alfieri, C. (2026) · Transplant International · doi:10.3389/ti.2026.16322
Metadata
- Authors
- Leow, Z. Z. X., Guelfi, K. J., Davis, E. A., Jones, T. W., & Fournier, P. A.
- Affiliations
- The University of Western Australia (AU)
- The Kids Research Institute Australia (AU)
- Corresponding author
- Leow, Z. Z. X.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2018-05-23
- Volume
- 35
- Issue
- 9
- Pages
- 1258-1263
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2799506931
- Cited by
- 115
- References
- 14
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 18 · 2023: 13 · 2022: 15 · 2021: 13 · 2020: 17 · 2019: 14 · 2018: 4
- FWCI
- 8.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- University of Western Australia
- Topics
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
- Keywords
- ketogenic diet, very low carbohydrate diet, type 1 diabetes, glycemic control, glycemic variability, hypoglycemia, dyslipidemia, lipid profile, continuous glucose monitoring, beta-hydroxybutyrate, liver and kidney function
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