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February 01, 2021
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Evidence suggests patients on low-carb diets achieve type 2 diabetes remission

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Patients with diabetes who consistently followed a low-carbohydrate diet for 6 months achieved a higher rate of remission — 32% — compared with mostly low-fat diets, according to a systematic review and meta-analysis.

“Type 2 diabetes remains a significant and worsening problem worldwide, despite many pharmaceutical developments and a global emphasis on glycemic control,” Joshua Goldenberg, MD, of the department of nutrition at Texas A&M University, and colleagues wrote. “Structured diets are recognized as an essential component of treating diabetes, but confusion remains about which diet to choose.”

The quote is: it would be nice to see data on patients who follow low carbohydrate diets for 2, 5 or even 10 years, because that is what my patients would want to know. The source of the quote is: Fatima Cody Stanford, MD, MPA, MPH, FAAP, FACP, FAHA, FTOS

The researchers reviewed 23 randomized clinical trials, five of which had previously unpublished HbA1c and medication use data. The analysis included 1,357 participants, with a mean age ranging from 46 to 67.8 years. According to Goldenberg and colleagues, 11% of the trial participants were female. The researchers reported that, compared with control diets, patients who adhered to low-carbohydrate diets (LCDs) achieved:

  • HbA1c levels lower than 6.5% (risk difference = 0.32; 95% CI, 0.17-0.47);
  • improvements in weight (mean difference = –3.46 kg; 95% CI, –5.25 to –1.67), triglycerides (mean difference = –0.3 mmol/L (95% CI, –0.43 to –0.17) and insulin sensitivity (mean difference = –0.14 (95% CI, –0.51 to 0.23); and
  • no significant difference in the Problem Areas in Diabetes scale.

Goldenberg and colleagues said the findings were based on “moderate- to low-certainty evidence.”

At 12 months, improvements in weight loss, triglycerides and insulin sensitivity dropped off, and the researchers also noted clinically important but not statistically significant worsening of quality of life and LDL cholesterol levels.

“We believe that our meta-analytic summary of published and unpublished data from eight randomized controlled trials using HbA1c thresholds, a first in the literature, will lead to more informed clinical decision-making in the management of type 2 diabetes,” Goldenberg and colleagues wrote.

The findings — along with those from a recent systematic review that indicated long-term LCDs are associated with increased mortality — suggest “clinicians might consider short-term LCDs for management of type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed,” the researchers wrote.