scholarly journals Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes—A Narrative Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Sean D. Wheatley ◽  
Trudi A. Deakin ◽  
Nicola C. Arjomandkhah ◽  
Paul B. Hollinrake ◽  
Trudi E. Reeves
Keyword(s):  
Type 2 Diabetes ◽  
Narrative Review ◽  
Carbohydrate Restriction ◽  
Nutrient Deficiencies ◽  
Relevant Research ◽  
New Approach ◽  
Low Carbohydrate ◽  
The Common

Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.

scholarly journals A Randomised Crossover Trial: Exploring the Dose-Response effect Of Carbohydrate restriction on glycaemia in people with type 2 diabetes (D-ROC2)

2021 ◽  
Author(s):  
Ebaa Al ozairi ◽  
Muhammad Abdul Ghani ◽  
Nick Oliver ◽  
Brandon Whitcher ◽  
Reem Al Awadi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Dose Response ◽  
Dietary Protein ◽  
Crossover Trial ◽  
Carbohydrate Restriction ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate ◽  
Dietary Treatments

The role of carbohydrate restriction in the management of glycemia in type 2 diabetes (T2D) has been a subject of immense debate and controversy partly due to low-carbohydrate trials being confounded by multiple factors including degree of calorie restriction, dietary protein content, and by no clear definition of a low-carbohydrate diet. The current study sought to provide insight into the relationship between carbohydrate restriction and glycemia by testing the effect of varying doses of carbohydrate on continuous glucose concentrations within a range of intakes defined as low-carbohydrate while controlling for confounding factors. This was a randomised crossover trial in participants with T2D testing 5 different 6-day eucaloric, isocaloric dietary treatments with varying carbohydrate contents (10%, 15%, 20%, 25%, and 30% kcal). Diets were kept isocaloric by exchanging %kcal from carbohydrate with predominantly unsaturated fat, keeping protein constant at 15% kcal. Daily self-weighing was employed to ensure participants maintained their weight throughout each treatment arm. Between dietary treatments, participants underwent a washout period of at least 7 days and were advised to maintain their habitual diet. Glycemic control was assessed using a continuous glucose monitoring device that was placed while the participant was on their normal diet, and was worn for the 6 days of each treatment. 12 participants completed the study. There were no differences in 24-hour and postprandial sensor glucose concentrations between the 30%kcal and 10%kcal doses (7.4 +/- 1.1mmol/L vs 7.6 +/- 1.4mmol/L (P=0.28) and 8.0 +/- 1.4mmol/L vs 8.3 +/- 1.3mmol/L (P=0.28) respectively). In our exploratory analyses we did not find any dose-response relationship between carbohydrate intake and glyaemia. A small amount of weight loss occurred in each treatment arm (range: 0.4 to 1.1kg over the 6 days) but adjusting for these differences did not influence the primary or secondary outcomes. Modest changes in dietary carbohydrate content in the absence of weight loss while keeping dietary protein intake constant do not appear to influence glucose concentrations in people with T2D.

scholarly journals The role of spousal support for dietary adherence among type 2 diabetes patients: a narrative review

2018 ◽  
Vol 58 (3) ◽  
pp. 304-323 ◽  
Author(s):  
Ariana M. Albanese ◽  
Jeff C. Huffman ◽  
Christopher M. Celano ◽  
Laura M. Malloy ◽  
Deborah J. Wexler ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Spousal Support ◽  
Narrative Review ◽  
Dietary Adherence ◽  
Diabetes Patients

scholarly journals Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments

2018 ◽  
Vol 108 (2) ◽  
pp. 300-331 ◽  
Author(s):  
Esther J van Zuuren ◽  
Zbys Fedorowicz ◽  
Ton Kuijpers ◽  
Hanno Pijl
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Clinical Importance ◽  
Carbohydrate Restriction ◽  
Dietary Carbohydrate ◽  
Low Fat ◽  
Low Carbohydrate

ABSTRACT Background It remains uncertain which diet is best for people with type 2 diabetes (T2D). Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D. Design This systematic review of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) compares the effects of a low-carbohydrate [≤40% of energy (%)] diet with those of a low-fat (≤30%) diet over a period of ≥4 wk in patients with T2D. Two investigators independently selected studies, extracted data, and assessed risk of bias. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the certainty of evidence. Pooled mean differences (MDs) and 95% CIs were calculated with the use of a random-effects model. Results Thirty-three RCTs and 3 CCTs (n = 2161) were included. Glycated hemoglobin declined more in people who consumed low-carbohydrate food than in those who consumed low-fat food in the short term (MD: –1.38%; 95% CI: –2.64%, –0.11%; very-low-certainty evidence). At 1 y, the MD was reduced to –0.36% (95% CI: –0.58%, –0.14%; low-certainty evidence); at 2 y, the difference had disappeared. There is low to high (majority moderate) certainty for small improvements of unclear clinical importance in plasma glucose, triglycerides, and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points. There was little to no difference in LDL concentration or any of the secondary outcomes (body weight, waist circumference, blood pressure, quality of life) in response to either of the diets (very-low- to high-certainty evidence). Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40% yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30% in people with T2D. This systematic review is registered at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017052467 as CRD42017052467.

scholarly journals Reversing Type 2 Diabetes: A Narrative Review of the Evidence

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 766 ◽  
Author(s):  
Sarah J Hallberg ◽  
Victoria M Gershuni ◽  
Tamara L Hazbun ◽  
Shaminie J Athinarayanan
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
American Diabetes Association ◽  
Healthcare Providers ◽  
Narrative Review ◽  
Carbohydrate Restriction ◽  
Short Term ◽  
Eating Pattern ◽  
Treatment Research

Background: Type 2 diabetes (T2D) has long been identified as an incurable chronic disease based on traditional means of treatment. Research now exists that suggests reversal is possible through other means that have only recently been embraced in the guidelines. This narrative review examines the evidence for T2D reversal using each of the three methods, including advantages and limitations for each. Methods: A literature search was performed, and a total of 99 original articles containing information pertaining to diabetes reversal or remission were included. Results: Evidence exists that T2D reversal is achievable using bariatric surgery, low-calorie diets (LCD), or carbohydrate restriction (LC). Bariatric surgery has been recommended for the treatment of T2D since 2016 by an international diabetes consensus group. Both the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) now recommend a LC eating pattern and support the short-term use of LCD for weight loss. However, only T2D treatment, not reversal, is discussed in their guidelines. Conclusion: Given the state of evidence for T2D reversal, healthcare providers need to be educated on reversal options so they can actively engage in counseling patients who may desire this approach to their disease.

A role for low-carbohydrate diets in type 2 diabetes

2019 ◽  
Vol 1 (6) ◽  
pp. 270-271
Author(s):  
George Winter
Keyword(s):  
Type 2 Diabetes ◽  
Potential Role ◽  
Diabetes Control ◽  
Carbohydrate Diet ◽  
Low Carbohydrate Diet ◽  
Low Carbohydrate

Prescribing for diabetes has increased in recent years. Here, George Winter discusses the potential role of a low-carbohydrate diet in type 2 diabetes control

scholarly journals Pharmacist-led therapeutic carbohydrate restriction as a treatment strategy for type 2 diabetes: the Pharm-TCR randomized controlled trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cody Durrer ◽  
Sean McKelvey ◽  
Joel Singer ◽  
Alan M. Batterham ◽  
James D. Johnson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Rapid Weight Loss ◽  
Carbohydrate Restriction ◽  
Glucose Lowering ◽  
Randomized Controlled ◽  
Equal Chance ◽  
Low Carbohydrate

Abstract Background The current treatment paradigm for type 2 diabetes mellitus (T2D) typically involves use of multiple medications to lower glucose levels in hope of reducing long-term complications. However, such treatment does not necessarily address the underlying pathophysiology of the disease and very few patients achieve partial, complete, or prolonged remission of T2D after diagnosis. The therapeutic potential of nutrition has been highlighted recently based on results of clinical trials reporting remission of T2D with targeted dietary approaches. During the initial phase of such interventions that restrict carbohydrates and/or induce rapid weight loss, hypoglycemia presents a notable risk to patients. We therefore hypothesized that delivering very low-carbohydrate, low-calorie therapeutic nutrition through community pharmacies would be an innovative strategy to facilitate lowering of glycated hemoglobin (A1C) while safely reducing the use of glucose-lowering medications in T2D. Methods A community-based randomized controlled trial that is pragmatic in nature, following a parallel-group design will be conducted (N = 200). Participants will have an equal chance of being randomized to either a pharmacist-led, therapeutic carbohydrate restricted (Pharm-TCR) diet or guideline-based treatment as usual (TAU). Pharm-TCR involves a 12-week very low carbohydrate, calorie-restricted commercial diet plan led by pharmacists and lifestyle coaches with pharmacists responsible for managing medications in collaboration with the participants’ family physicians. Main inclusion criteria are diagnosis of T2D, currently treated with glucose-lowering medications, age 30–75 years, and body mass index ≥ 30. The primary outcome is a binary measure of use of glucose-lowering medication. Secondary outcomes include A1C, anthropometrics and clinical blood markers. Discussion There are inherent risks involved if patients with T2D who take glucose-lowering medications follow very low carbohydrate diets. This randomized controlled trial aims to determine whether engaging community pharmacists is a safe and effective way to deliver therapeutic carbohydrate restriction and reduce/eliminate the need for glucose-lowering medications in people with T2D. Trial registration ClinicalTrials.gov, NCT03181165. Registered on 8 June 2017.

scholarly journals Restricting carbohydrates and calories in the treatment of type 2 diabetes: a systematic review of the effectiveness of ‘low-carbohydrate’ interventions with differing energy levels

2021 ◽  
Vol 10 ◽  
Author(s):  
Anna P. Nicholas ◽  
Adrian Soto-Mota ◽  
Helen Lambert ◽  
Adam L. Collins
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Clinical Trials ◽  
Energy Intake ◽  
Average Weight ◽  
Carbohydrate Restriction ◽  
Low Carbohydrate ◽  
Ad Libitum

Abstract There are two proven dietary approaches to shift type 2 diabetes (T2D) into remission: low-energy diets (LEDs) and low-carbohydrate diets (LCDs). These approaches differ in their rationale and application yet both involve carbohydrate restriction, either as an explicit goal or as a consequence of reducing overall energy intake. The aims of this systematic review were to identify, characterise and compare existing clinical trials that utilised ‘low-carbohydrate’ interventions with differing energy intakes. Electronic databases CENTRAL, CINAHL, Embase, MEDLINE and Scopus were searched to identify controlled clinical trials in adults with T2D involving low-carbohydrate intake (defined as <130 g carbohydrate/d) and reporting weight and glycaemic outcomes. The initial database search yielded 809 results, of which fifteen studies met the inclusion criteria. Nine out of fifteen studies utilised LCDs with moderate or unrestricted energy intake. Six trials utilised LEDs (<1200 kcal/d), with all except one incorporating meal replacements as part of a commercial weight loss programme. Interventions using both restricted and unrestricted (ad libitum) energy intakes produced clinically significant weight loss and reduction in glycated haemoglobin (HbA1c) at study endpoints. Trials that restricted energy intake were not superior to those that allowed ad libitum low-carbohydrate feeding at 12 and 24 months. An association was observed across studies between average weight loss and reduction in HbA1c at 6, 12 and 24 months, indicating that sustained weight loss is key to T2D remission. Further research is needed to specifically ascertain the weight-independent effects of carbohydrate restriction on glycaemic control in T2D.

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