Low-carbohydrate diet improves glycemia for adults with elevated HbA1c, prediabetes
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A low-carbohydrate dietary intervention resulted in improved glycemia for adults with elevated HbA1c who were not on glucose-lowering medications, according to trial results published in JAMA Network Open.
“If sustained, interventions that lower HbA1c in the short-term may lead to type 2 diabetes prevention, as was observed in the Diabetes Prevention Program trial,” Kirsten S. Dorans, ScD, assistant professor in the department of epidemiology at Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, and colleagues wrote. “To our knowledge, only two pilot trials have assessed glycemic effects of low-carbohydrate diets in participants with prediabetes.”
This 6-month randomized clinical trial included 150 participants (mean age, 58.9 years; 72% women) aged 40 to 70 years with untreated HbA1c of 6% to 6.9% and was conducted from September 2018 to June 2021 in New Orleans. All participants were randomly assigned to the low-carbohydrate diet intervention with a target of less than 40 net grams of carbohydrates in the first 3 months and less than 60 net grams from 3 to 6 months including dietary counseling (n = 75) or usual diet (n = 75).
Most participants (95%) had data collected for all 6 months of the study period. At 6 months, participants in the low-carbohydrate intervention had greater reductions in HbA1c (net difference, –0.23%; 95% CI, –0.32 to –0.14; P < .001), fasting plasma glucose (net difference, –10.3 mg/dL; 95% CI, –15.6 to –4.9; P < .001) and body weight (net difference, –5.9 kg; 95% CI, –7.4 to –4.4; P < .001) compared with participants who received the usual diet.
Participants in the intervention group also experienced significantly greater decreases in fasting insulin (–4 µIU/L vs. 2.3 µIU/L), homeostasis model assessment of insulin resistance (–3.2 mm Hg vs. –0.6 mm Hg) and waist circumference (–5.2 cm vs. –0.5 cm) at 6 months compared with the usual diet group. In addition, at 6 months, the intervention group also experienced –7 mg/dL lower mean 24-hour glucose compared with the usual diet group.
Researchers also observed a significantly greater decrease in systolic blood pressure from baseline to 3 months among participants in the intervention group.
“This dietary approach may be an option for people with or at high risk of type 2 diabetes to improve glycemic and other markers and should be studied further and over longer time periods in other populations and settings,” the researchers wrote.
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