Interventi dietetici per adulti con diabete di tipo 1: esiti clinici, allineamento alle linee guida e lacune nella ricerca - una revisione di scoping

Background/Objectives: Medical nutrition therapy (MNT) is a crucial component of type 1 diabetes (T1D) management; however, the effectiveness of specific dietary approaches in adults remains unclear due to variations in study design, terminology, and reported outcomes. This scoping review summarizes evidence published between 2015 and 2025 on dietary interventions in adults with T1D, focusing on metabolic and psychosocial outcomes and adherence to international nutritional guidelines. Methods: We searched PubMed, Web of Science, Scopus, and Google Scholar, following the PRISMA-ScR recommendations, to identify observational studies, randomized clinical trials (RCTs), and guidelines involving adults (≥18 years) with T1D. Extracted data included metabolic outcomes (glycated hemoglobin A1c (HbA1c), glycemic variability (GV), insulin dose (ID), lipids, blood pressure, body weight, and others), as well as psychosocial indicators (i.e., quality of life, diabetes-related stress, and fear of hypoglycemia). Results: In total, 41 studies met the inclusion criteria, comprising 18 observational, 14 randomized, and 9 studies that evaluated psychosocial aspects. A low-carbohydrate diet (LCD) reduced HbA1c by 0.3–0.9% and total ID by approximately 15–20% without increasing the incidence of severe hypoglycemia. A low-fat vegan diet and structured carbohydrate counting (CC) programs also improved glycemic and lipid profiles. The Mediterranean diet (MedDiet) and plant-based diet mainly improved diet quality and well-being. The results showed an association between better metabolic control and lower carbohydrate (CHO) intake, as well as higher intakes of fiber and protein. In contrast, a Western diet and high intake of sweets were linked to poorer outcomes. Conclusions: Combining an LCD with education, CC, and modern diabetes technology provides the most consistent benefits for adults with type 1 diabetes (T1D adults). The MedDiet and plant-based diet support diet quality and psychosocial well-being, although current evidence remains limited, primarily due to small sample sizes and short follow-up periods.