years about half of the individuals had ceased adhering. The other half (group C
D) achieved a stable lowering of HbA1c. This is clinically significant. The tissue destructions from hyperglycemia accumulate steeply in the type 1 diabetes population [1
]. The HbAc1 reduction therefore, even in this little group, already after a few years corresponds to a number of people avoiding complications [1
The calculated number of persons who have avoided complications over 4
years among the 23 persons are: Retinopathy progression 2-3 persons (8-11%); laser treatment 1 person (4%); neuropathy 5-6 persons (22-26%); severe retinopathy 1 (4%). About 1 person (4%) per 5
years can be expected to avoid macular edema, and 1 person to avoid a cardiovascular event [1
The ratio Chol/HDL is a marker of a specific risk for myocardial infarction [11
]. The changes here correspond to a 20% reduction in this risk. The difference in HbA1c reduces the risk of cardiovascular disease by about 40% [1
]. Substitution of fat for carbohydrates is generally more beneficial for risk of cardiovascular disease in both normal- and overweight persons than the widely recommended low-fat diet [12
There is no reason to assume that the patients here are different from the rest of Sweden. The number of adults with type 1 diabetes in Sweden is about 40,000 and the number cared for by the present diabetes unit is about 300.
The 23 persons in group C
D constitute about 7.6% of all persons with type 1 diabetes cared for by the present unit. The figures in group C
D correspond to about 3,100 adults with type 1 diabetes in Sweden who might be expected to adapt to the present approach and avoid a substantial number of complications.
A small group D, 27% of the subjects, without exception adapted excellently and achieved a constant mean HbA1c lowering by 1.8 percentage point. This group constitutes about 4.3% of all individuals with type 1 diabetes connected to the present unit, and corresponds to about 1,700 of all adults with type 1 diabetes in Sweden.
Only a limited number of patients, about 16-18%, in contact with the present unit have been interested in such a change of diet as described.
There is no evidence for the use of the widely recommended high-carbohydrate, low-fat diet in type 1 diabetes.
There is no evidence that animal fat in the food should cause cardiovascular disease [13
]. There is no evidence that protein should cause kidney disease [16
]; on the contrary, hyperglycemia gave a 3.5 times higher incidence of albuminuria in DCCT, not protein [1
]. There is, however, strong evidence for the aggressive development of damages in all organs in poorly regulated type 1 diabetes [1
The physician and the individual must therefore together explore the tools and methods that give best result, for instance type of insulin, insulin pens, insulin pump etc. and diet. The restricted carbohydrate dietary approach is directly aimed at lowering of HbA1c, not at avoiding fat and protein. The model described here may be an option for 10-20% of the patients with type 1 diabetes.