Study finds low-carb diets have potential to drive diabetes remission

A new study investigating the efficacy and safety of low carbohydrate diets and very low carbohydrate diets for people with type 2 diabetes, found those who adhered to a low-carbohydrate diet after six months had the greatest health improvements.
 
The first systematic review to examine the safety and efficacy of such diets in adults and to assess remission rates of type 2 diabetes examined the combined effects of 23 international clinical trials involving 1357 participants. Additional data from five of those clinical trials on markers of blood sugar status was also included.
 
Those who followed a diet containing less than 26% of daily calories from carbohydrates achieved greater rates of type 2 diabetes remission than those who followed other diets traditionally recommended for managing the disease.
 
Building on existing research, the study authors concluded that a low-carbohydrate diet can help to achieve greater weight loss and is more effective in reducing diabetes medication and improving blood glucose control.
 
In further developments, it showed the low-carbohydrate dietary approach to be effective in driving type 2 diabetes into remission, suggesting such diets could be considered an effective alternative, while monitoring and adjusting diabetes medication as needed.
 
However, Dr Gary Deed, Chair of the RACGP Specific Interests Diabetes network, has some hesitancy.
 
He told newsGP that although the new research shows some promising results, the issues of translating clinical trials to clinical efficacy is an important factor.
 
‘Diet change is part of the story, but carbohydrates are not the only sentence in this book,’ he said.
 
‘Where is the lifecycle of diabetes for patients that were placed into remission? If the diabetes is longer term does this method work, and if so, in which patients does the remission last longer than the allotted timeframe of the trials?’
 
He also highlighted that low-carbohydrate diets are not a panacea for the ‘many issues’ that arise when a person has diabetes.
 
‘Remember, people develop diabetes and it is not purely a carbohydrate-intolerance condition as some have labelled it,’ he said.
 
‘There are complex pathophysiological processes affecting not just carbohydrate metabolism, with implications for multiple systems in the body, let alone a person’s lifestyle and mental health.
 
‘Not all people can sustain a complex dietary change – and it is not because they lack will power – the many social determinants that affect health play a complex web of effects in all of our lives.’
 
Dr Deed said it is also important to use the term ‘remission’ rather than ‘reversal’ in this context, particularly when the study criteria are unclear.
 
‘[The term] “reversal” has implications that mean the pathophysiological process that led to diabetes correcting itself completely,’ he said.


Dr Gary Deed warns that low-carbohydrate diets are not a panacea for the many issues that arise when a person has diabetes.

Citing the study’s ‘moderate to low certainty evidence’ that patients adhering to low-carbohydrate diet for six months may experience remission of diabetes without adverse consequences, Dr Deed believes this may not be the case.
 
‘Further remitting of weight loss may be related to further onset of hyperglycaemia and the type 2 diabetes returning,’ he said.
 
‘It is important to note that people with impaired glucose parameters below the diagnostic criteria for diabetes accompanies an elevated cardiovascular risk – that must also not be ignored.
 
‘Thus, persons who have the glucose reduced by dietary and weight change may not have fully eliminated there risk factors for heart and vascular disease … so the word “reversal” is prone to misunderstanding by people not fully being aware of the underlying risks.’
 
The RACGP’s diabetes general practice handbook, for which Dr Deed is clinical editor, states that the total amount of carbohydrates consumed may be the major dietary factor that contributes to high blood glucose levels after eating.
 
Dr Deed recommends an individual approach to monitoring patients’ diets.
 
‘My advice is that ad hoc adjustment of dietary carbohydrates without addressing whole-of-health eating plans is prone to causing nutritional imbalances and or deficiencies,’ he said.
 
‘The quality and quantity of carbohydrates needs to be worked out with each indifferent patient related to their lifecycle stage of diabetes and current medication/lifestyle, etc.
 
‘It may need careful advice – an accredited practicing dietitian is always advisable – especially if there is a need for self-monitoring of blood glucose levels and use of medications that can induce hypoglycaemia.’
 
He also cautions that a low-carbohydrate diet may cause risks in some patients who are utilising sodium-glucose co-transporter-2 (SGLT2) inhibitors, raising risks of a potentially fatal euglycaemic diabetic ketoacidosis (DKA).
 
The study authors anticipate the new research will assist both healthcare providers and patients to better understand how a focus on dietary approach can be used to treat type 2 diabetes, by examining the evidence on the effects of low-carbohydrate diets against clinical targets.
 
But also Dr Deed says a holistic approach is needed, in which GPs are central.
 
‘GPs can support [patients with diabetes] to individually address their health problems in a sustainable and patient-focused way,’ Dr Deed said.
 
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