The participants were confirmed as having a positive diabetes antibody test result, a diagnosis of diabetes prior to the age of 20, and a body mass index (BMI) under 30 for adults or lower than the 95% percentile for children. The international cohort included individuals from the U.S., Canada, Europe, and Australia. The findings held similar across pediatric and adults patients.
The pediatric patients' healthcare providers reported that clinical data on the children included in the analysis showed a "marginal decrease" in height following T1D diagnosis: "This possible growth deceleration may have preceded or occurred during the diet and is comparable in magnitude to the previously described decreases in height SDS in T1DM," the researchers suggested, adding that "taken together, these data do not reveal an adverse effect of a VLCD on growth, but additional research into this possibility is warranted."
In an accompanying commentary, Carly Runge and Joyce M. Lee, MD, MPH, both of the University of Michigan in Ann Arbor, praised the study, calling it "an important contribution to the literature." However, they said, a key question that remains is the potential impact the diet may have on pediatric growth, noting that a limitation of the study was the inability to assess pubertal development. Runge and Lee called for a randomized controlled study, to assess not only the effect on HbA1c, but also the frequency of diabetic ketoacidosis, hypoglycemia, BMI, linear growth outcomes, cholesterol, and percentage of time in range.
"Only after the therapy proves efficacious in a trial setting will clinicians have to then tackle the 'barrier' of having patients adhere to this diet.".