Long-term management of type-2 diabetes can be improved by following a strict low carbohydrate diet, a new study, conducted by physicians of Norwood Surgery in United Kingdom, has found.
Published in the journal BMJ Nutrition, Prevention & Health, the study showed that a low-carb diet was effective in achieving glycemic control in people with type-2 diabetes. More than half of the participants in the study, who adopted the low-carb diet achieved type-2 diabetes remission which meant they were able to eventually stop taking medications.
For the study, the physicians examined health outcomes of 186 adults with long-terms type-2 diabetes, all of whom followed a low-carb diet over an average follow-up period of 33 months. During routine visits over the follow-up period, the physicians provided the participants with advice on maintaining a low-carb diet and shared information about how this diet could help achieve better blood glucose control.
They also provided advice on how trigger foods can be identified and avoided. These are highly palatable foods that lead to overeating. In addition to one-to-one consultations, the participants also had the option to attend group sessions to gain practical knowledge about choosing and preparing low-carb foods.
Observation and analysis of the collected data revealed that the type-2 diabetes patients who had opted for the low-carb diet, showed an average decline in body weight of about 10kg. Furthermore, around 97% of the patients following such a diet showed a significant decline in HbA1c (glycated haemoglobin A1c) levels during follow-up period. This is a form of haemoglobin that is bound to glucose and reflects the average blood glucose levels during the previous two to three months.
Researchers also observed that participants, who followed a low-carb diet, showed lower cardiovascular disease markers at the end of the follow-up period. Indicators such as average blood pressure, triglyceride levels and low-density lipoprotein cholesterol (LDL cholesterol) levels showed a significant reduction during the follow-up period.
In the entire group of 186 individuals, 94 patients (51%) showed sustained remission, achieving HbA1c levels below the remission threshold of 48mmol/mol for more than three months. Participants, who achieved remission, showed greater weight loss than those who did not achieve remission. Additionally, all those who achieved sustained remission showed at least some weight loss.
The results also indicated that individuals with higher HbA1c levels at the onset of the low-carb diet showed larger reductions in HbA1c levels. However, those with lower HbA1c levels were more likely to achieve remission. This was likely due to the more recent diabetes diagnosis of participants who had lower HbA1c at the start of the diet.
Further analyses, revealed that 77% of participants who adopted a low-carb diet within the first year after their type-2 diabetes diagnosis achieved remission. In contrast, 35% and 20% of the participants adopting the low-carb diet between one and five years and more than 15 years after their diabetes diagnosis, respectively, achieved remission.
Even though a lower proportion of participants with a longer duration of type-2 diabetes achieved remission, the researchers believe that a low-carb diet could help achieve clinically significant improvements in glyaecmic control in patients with poorly controlled type-2 diabetes as well. They also acknowledged that medications could also be necessary for the management of longer-duration type-2 diabetes.
There have been other studies that have also examined the effectiveness of low-carb diet for achieving blood sugar control, but most have failed to achieve similar levels of weight loss. Researchers of this study believe this could be attributed to patient-physician trust, open discussion of the merits of weight loss for long-term health and ongoing support.
For instance, the physicians in this study, monitored the patient’s weight and HbA1c levels and provided reminders over the telephone when these parameters increased. This was generally due to an increase in carbohydrate intake and the phone call was sufficient to ensure adherence to the low-carb diet. The study also found that the clinic spent half as much on medications for diabetes per patient than other local practices.
However, it is important to note that the study is also limited by a risk of bias, as only the patients who were motivated to improve their health may have opted for the low-carb diet. Only 186 out of the 473 type-2 diabetes patients opted for the low-carb diet, indicating a reluctance to follow the dietary regimen. Furthermore, the study was also observational in nature and lacked a control group.
Dr David Unwin, the lead author of this study, is, nevertheless, excited about the findings and is certain that the results are a reason for further detailed investigation.
