Abstract
Background: The ketogenic diet has gained substantial popularity in recent years, and an increasing number of caregivers of children with type 1 diabetes are considering it as a nutritional strategy to improve glycemic control. Reported benefits include fewer postprandial glucose fluctuations, lower insulin requirements, and reduced insulin-associated weight gain. However, the use of this diet in children with type 1 diabetes remains highly debated, and scientific evidence regarding its safety and long-term effects in the pediatric population is limited. This narrative review aims to explore the motivations that lead parents to initiate a ketogenic diet in their children with type 1 diabetes and to summarize current knowledge on its potential metabolic and developmental consequences. Methods: A narrative review of the literature was conducted, including original research articles, case reports, and existing reviews addressing the use of ketogenic diets in children with type 1 diabetes. Clinical observations and published accounts of family experiences were also examined to contextualize emerging concerns and motivations. Results: Parents most commonly adopt a ketogenic diet for their children due to the desire for tighter glucose control, concerns about insulin-related weight gain, and the influence of information shared on social media. Some observational data suggest improvements in glycemic stability and reduced insulin requirements under ketogenic dietary regimens, while available evidence also highlights several potential risks, including dyslipidemia, increased susceptibility to hypoglycemia, slowed linear growth, and possible neurocognitive and psychosocial effects. Long-term safety data remain scarce, and current findings are insufficient to establish clear clinical recommendations. Conclusions: Interest in ketogenic diets among families of children with type 1 diabetes is growing, yet existing evidence suggests that the diet may pose significant metabolic and developmental risks in this population. Further well-designed studies are needed to evaluate its safety and efficacy. This review may assist clinicians in counseling families and underscores the need for evidence-based guidelines regarding restrictive dietary patterns in youth with type 1 diabetes.