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January 2021

Short term low carbohydrate diet linked to remission of type 2 diabetes

Patients with type 2 diabetes who follow a strict low carbohydrate diet for six months may experience greater rates of remission compared with other recommended diets without adverse effects, suggests a study published in The BMJ.

The researchers acknowledge that most benefits diminished at 12 months, but say doctors might consider short term strict low carbohydrate diets for managing type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.

Diet is recognised as an essential part of treatment for type 2 diabetes, but uncertainty remains about which diet to choose.

To address this evidence gap, a team of international researchers compared the effectiveness and safety of low carbohydrate diets (LCDs), very low carbohydrate diets (VLCDs) for people with type 2 diabetes, with (mostly low fat) control diets.

Their findings are based on analysis of published and unpublished data from 23 randomised trials involving 1,357 participants.

LCDs were defined as less than 26% daily calories from carbohydrates and VLCDs were defined as less than 10% daily calories from carbohydrates for at least 12 weeks in adults (average age 47 to 67 years) with type 2 diabetes.

The researchers found that patients on LCDs achieved higher diabetes remission rates at six months compared with patients on control diets, without adverse events. Those following a LCD experienced, on average, a 32% absolute risk reduction (28 fewer cases per 100 followed) in diabetes remission at 6 months.

LCDs also increased weight loss, reduced medication use, and improved body fat (triglyceride) concentrations at six months. However, most of these benefits diminished at 12 months.

These results are based on moderate to low certainty evidence, but suggest clinicians ‘might consider short term LCDs for management of type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.’

Goldenberg JZ, et al. BMJ 2021;372:m4743

Practice Nurse 2021;51(1):5