Type 1 diabetes: dietary modification over 100 years since insulin

Abstract

Diet has been central for the management of type 1 diabetes for over three thousand years, and the discovery of insulin in 1921 was associated with the introduction of formal dietary education. Carbohydrate was soon identified as the macronutrient responsible for postprandial glucose excursions and over the past one hundred years, dietary interventions have alternated between severe carbohydrate restriction and so-called free diets. The very low carbohydrate diets of the 1920s gave way to the free diets of the 1930s, and carbohydrate restriction was then reintroduced in the 1940s to the 1960s. In the 1970s, carbohydrate intake was increased with an emphasis on dietary fibre and low fat, healthy eating was recommended in the 1980s. The past few decades have reflected the growing evidence following the DCCT and DAFNE trials and dietary interventions are now individualised and emphasise carbohydrate counting and insulin adjustment and quality of life. Copyright © 2021 John Wiley & Sons.