‘Reasonable to low’ high quality proof for diabetes remission with low-carb diets


medwireNews: A systematic review and meta-analysis shows a potential increase in the likelihood of achieving type 2 diabetes remission on a low-carb or low-carb diet based on signs of moderate or poor quality.

However, the extent of the effect depended on the definition of remission. Bradley Johnston (Texas A&M University, College Station, USA) and co-researchers found a significant 1.87 for the definition of achieving glycated hemoglobin (HbA1c) below 6.5% (48 mmol / mol) with or without medication -fold increased probability. with moderate certainty.

In particular, the remission rate for 6 months on a low-carbohydrate diet was 59 per 100 participants, compared with 31 per 100 for a control diet, which was a low-fat diet in 78% of the 23 studies analyzed.

For the stricter definition of HbA1c below 6.5% in the absence of glucose-lowering drugs, the relative increase in low-carbohydrate versus control diets was 1.24-fold insignificant with a low certainty. In this case, remission rates were 16 versus 13 per 100 participants on a low-carbohydrate versus control diet.

The analysis included a total of 1357 participants, and the number per study ranged from 12 to 144. All studies included a diet that provided less than 26% of the calories from carbohydrates or less than 130 g / day, and 52% met the researchers’ criteria for a low-carbohydrate diet that was less than 10% of the calories from carbohydrates or less than 50 g / day.

Participants on low-carbohydrate diets were significantly more likely to reduce their diabetes medication than participants on control diets. They also lost more weight, an average of 7.41 kg in studies with a low risk of bias.

However, the remission, medication, and weight loss benefits after 6 months had disappeared after 12 months with no significant differences between the low-carb and control diets, reports the team at the BMJ.

A low-carb diet was associated with significant and clinically important improvements in triglyceride levels at both 6 and 12 months.

“However, we saw a trend towards clinically important increases in low-density lipoprotein cholesterol after 12 months,” say the researchers.

Although the increase was not significant, it exceeded the team’s predefined threshold for minimal clinically important difference.

“Given that and a recent systematic review of cohort studies that suggest this is long term [low-carbohydrate diets] are associated with increased mortality, doctors may consider in the short term [low-carbohydrate diets] for the treatment of type 2 diabetes while actively monitoring and adjusting diabetes medication as needed, ”conclude Johnston and his team.

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BMJ 2021; 372: m4743