Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort

Abstract

ObjectiveThe optimal diet to improve glycemia in patients with type 2 diabetes remains unclear. Low carbohydrate, high fat (LCHF) diets can improve glycemic control, but have not been investigated in real-world settings.Research design and methodsWe investigated effects of the LCHF diet compared with usual care in a community-based cohort of patients with type 2 diabetes by performing a retrospective study of 49 patients who followed the LCHF diet for ≥3 months, and compared glycemic outcomes with age-matched and body mass index (BMI)-matched controls who received usual care (n=75). The primary outcome was change in A1C from baseline to the end of follow-up.ResultsCompared with the usual care group, the LCHF group showed a significantly greater reduction in A1C (−1.29% (95% CI −1.75 to −0.82; p<0.001)) and body weight (−12.8 kg (95% CI −14.7 to −10.8; p<0.001) at the end of follow-up after adjusting for age, sex, baseline A1C, BMI, baseline insulin dose. Of the patients initially taking insulin therapy in the LCHF group, 100% discontinued it or had a reduction in dose, compared with 23.1% in the usual care group (p<0.001). The LCHF group also had significantly greater reduction in fasting plasma glucose (−43.5 vs −8.5 mg/mL; p=0.03) compared with usual care.ConclusionsIn a community-based cohort of type 2 diabetes, the LCHF diet was associated with superior A1C reduction, greater weight loss and significantly more patients discontinuing or reducing antihyperglycemic therapies suggesting that the LCHF diet may be a metabolically favorable option in the dietary management of type 2 diabetes.

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“…In a RCT by Retterstol et al, a low carbohydrate diet coupled with high dietary fat intake has been found to increase plasma LDL-C by 44% (range between 5% and 107%) compared to the control group in normal weight individuals over a period of 3 weeks [ 86 ], which could increase CVD risk. However, studies on the metabolic effects of low carbohydrate high fat diets, namely on lipid profile, report inconsistent findings and while some do not note any differential impact, others indicate improvements in lipid markers among a range of other metabolic benefits including greater reductions in HbA1C and better glycemic control in patients with type 2 diabetes [ 87 , 88 , 89 ]. A low intake of carbohydrates, namely dietary fibers, is also known to be associated with negative effects on the gut function and overall health [ 90 , 91 ].…”

Service user and community clinician design of a partially virtual diabetic service improves access to care and education and reduces amputation incidence

“…27 28 This approach has been reported with similar results in another center. 29 ► Eight who engaged with the Unwin diet experienced a reduction in weight from 110.2±19 to 101.5±20 kg and of HbA1c from 52.8±7 to 45.2±3.4 mmol/mol, at 1 year, p=0.00003 for both weight loss and reduction in HbA1c.…”

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