Study Links Short-Term Low Carbohydrate Diet to Remission of Type 2 Diabetes

A new study published in The BMJ found that patients with type 2 diabetes (T2D) who follow a strict low carbohydrate diet for 6 months may experience greater rates of remission without adverse effects compared to patients who follow other recommended diets.

T2D is the most common form of diabetes, and although experts recognize that diet is an essential part of treatment, there is uncertainty about which diet to choose. Previous studies have reported mixed results when investigating diet changes as a treatment for diabetes. The study authors acknowledged that most benefits of the low carbohydrate diet diminished at 12 months, but they said physicians might consider short-term strict low carbohydrate diets for patients with T2D, while actively monitoring and adjusting medications as needed.

To address the evidence gap, a team of investigators assessed the effectiveness and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for individuals with T2D, compared to control diets, which were mostly low fat. Their findings are based on an analysis of published and unpublished data from 23 randomized trials involving 1357 participants.

LCDs were defined as less than 26% of daily calories from carbohydrates, whereas VLCDs were defined as less than 10% of daily calories for at least 12 weeks in adults. The outcomes were reported at 6 and 12 months and included remission of diabetes, weight loss, adverse events (AEs), and health-related quality of life.

Based on low- to moderate-certainty evidence, the investigators found that patients on LCDs achieved higher diabetes remission rates at 6 months compared with patients on control diets. Furthermore, these results were achieved without AEs.

For example, the authors said that based on moderate certainty evidence from 8 trials with 264 participants, those following an LCD diet experienced, on average, a 32% absolute risk reduction in diabetes remission at 6 months. This totals 28 fewer cases per 100 patients followed. LCDs also increased weight loss, reduced medication use, and improved body fat concentrations at 6 months.

Despite these encouraging findings, the authors noted that most of these benefits diminished after a year. This finding is consistent with previous reviews, and some evidence showed worsening quality of life and cholesterol levels at 12 months. Based on these findings, the study authors said clinicians should consider short-term LCDs for the management of T2D, in addition to active monitoring and adjustments of medications when necessary.

“Future long-term, well designed, calorie controlled randomized trials are needed to determine the effects of LCD on sustained weight loss and remission of diabetes, as well as cardiovascular mortality and major morbidity,” the authors concluded.

REFERENCE

Short term low carbohydrate diet linked to remission of type 2 diabetes [news release]. EurekAlert; January 13, 2021. https://www.eurekalert.org/pub_releases/2021-01/b-stl011221.php. Accessed January 18, 2021.