Dynamics of glucose concentration during the initiation of ketogenic diet treatment in children with refractory epilepsy: Results of continuous glucose monitoring.
Level 4 - case-series / case-control
Prospective single-arm case series without an external control group
PubMed 37345572 · doi:10.1002/epi4.12778
What was done
Ten pediatric patients (6 boys, mean age 6.1 ± 2.4 years) with intractable epilepsy were monitored using a blinded Dexcom G4 continuous glucose monitoring (CGM) system during ketogenic diet initiation. Patients spent the first 36 hours on their regular diet, followed by a stepwise increase in dietary fat-to-nonfat ratios (1:1, 2:1, 3:1, and 3.5:1). Glycemic changes across diet phases were evaluated using a generalized linear model over an average monitoring period of 6 days, 10 hours, and 44 minutes per patient.
What was found
Mean blood glucose progressively decreased as the fat ratio increased: 4.84 ± 0.20 mmol/L on the regular diet, 4.03 ± 0.16 mmol/L at 1:1, 3.57 ± 0.10 mmol/L at 2:1, 3.39 ± 0.13 mmol/L at 3:1, and 2.79 ± 0.06 mmol/L at 3.5:1 (P < 0.001). The proportion of time spent with glucose ≤3.5 mmol/L increased from 0.88% on the regular diet to 1.92% at 1:1, 3.18% at 2:1, and 13.64% during the 3:1 and 3.5:1 phases (P < 0.05). Time spent with glucose ≤2.5 mmol/L similarly rose from 0.31% at baseline to 0.95% (1:1), 1.02% (2:1), and 2.36% (3:1 and 3.5:1).
Why it matters
The findings demonstrate that continuous glucose monitoring can capture real-time glycemic drops and transient hypoglycemic episodes during the initial gradual induction of a ketogenic diet in pediatric patients.
Limits
The sample size was very small (n = 10), and there was no control group. The abstract does not report whether hypoglycemic episodes were clinically symptomatic, how hypoglycemia was managed, or the long-term clinical seizure outcomes.
Cited by
- context Adherence to a ketogenic diet results in a continuous glucose monitor trace that is completely flat, absent major exercise or severe stress.