Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up

Background: Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect. We previously reported that a 20% carbohydrate diet was significantly superior to a 55-60% carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control. Method: Retrospective follow-up of previously studied subjects on a low carbohydrate diet. Results: The mean bodyweight at the start of the initial study was 100.6 +/- 14.7 kg. At six months it was 89.2 +/- 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 +/- 4.2 kg to an average of 92.0 +/- 14.0 kg. Seven of the 16 patients (44%) retained the same bodyweight from 6 to 22 months or reduced it further; all but one had lower weight at 22 months than at the beginning. Initial mean HbA1c was 8.0 +/- 1.5%. After 6 and 12 months it was 6.6 +/- 1.0% and 7.0 +/- 1.3%, respectively. At 22 months, it was still 6.9 +/- 1.1%. Conclusion: Advice on a 20% carbohydrate diet with some caloric restriction to obese patients with type 2 diabetes has lasting effect on bodyweight and glycemic control.