Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Diabetes Therapy
Published in: Diabetes Therapy 4/2015

Open Access 01-12-2015 | Review

Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?

Author: Pamela Dyson

Published in: Diabetes Therapy | Issue 4/2015

Login to get access

Abstract

Introduction

Low carbohydrate diets are again in the spotlight and have been identified as particularly appropriate for people with type 2 diabetes. There is confusion amongst both health professionals and people with diabetes about the suitability of these diets. This review aims to provide an overview of the latest evidence and to explore the role of low carbohydrate diets for people with type 2 diabetes.

Methods

An electronic search of English language articles was performed using MEDLINE (2010–May 2015), EMBASE (2010–May 2015), and the Cochrane Central Register of Controlled Trials (2010–May 2015). Only randomized controlled trials comparing interventions evaluating reduced carbohydrate intake with higher carbohydrate intake in people with diagnosed type 2 diabetes were included. Primary outcomes included weight, glycated hemoglobin, and lipid concentrations.

Results

Low carbohydrate diets in people with type 2 diabetes were effective for short-term improvements in glycemic control, weight loss, and cardiovascular risk, but this was not sustained over the longer term. Overall, low carbohydrate diets failed to show superiority over higher carbohydrate intakes for any of the measures evaluated including weight loss, glycemic control, lipid concentrations, blood pressure, and compliance with treatment.

Conclusion

Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.
Literature
1.
Tattersall B. Diabetes: the biography. Oxford: Oxford University Press; 2009.
2.
3.
4.
Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31:1–13.CrossRefPubMed
5.
Dyson PA, Kelly T, Deakin T, on behalf of Diabetes UK Nutrition Working Group, et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2011;28:1282–8.CrossRefPubMed
6.
Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37:S120–43.CrossRefPubMed
7.
Dyson P. A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes. J Hum Nutr Diet. 2008;21:530–8.CrossRefPubMed
8.
Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc. 2008;108:91–100.CrossRefPubMed
9.
Castañeda-González LM, Bacardí Gascón M, Jiménez Cruz A. Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. Nutr Hosp. 2011;26:1270–6.PubMed
10.
Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014;9:e100652.PubMedCentralCrossRefPubMed
11.
12.
Adam-Perrot A, Clifton P, Bronus F. Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev. 2006;7(1):49–58.CrossRefPubMed
13.
Atkins RC. Dr Atkins new diet revolution. New York: Avon Books, HarperCollins; 2003.
14.
Sears B. The zone: a dietary road map. New York: HarperCollins; 1995.
15.
Agatston A. The South Beach Diet. New York: St Martin’s Press; 2003.
16.
Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97:505–16.CrossRefPubMed
17.
18.
Iqbal N, Vetter ML, Moore RH, et al. Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants. Obesity. 2010;18:1733–8.CrossRefPubMed
19.
Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010;12:204–9.CrossRefPubMed
20.
Larsen RN, Mann NJ, Maclean E, Shaw JE. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial. Diabetologia. 2011;54:731–40.CrossRefPubMed
21.
Guldbrand H, Dizdar B, Bunjaku B, et al. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia. 2012;55:2118–27.PubMedCentralCrossRefPubMed
22.
Krebs JD, Bell D, Hall R, et al. Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes. J Am Coll Nutr. 2013;32:11–7.CrossRefPubMed
23.
Mayer SB, Jeffreys AS, Olsen MK, McDuffie JR, Feinglos MN, Yancy WS Jr. Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes. Diabetes Obes Metab. 2014;16:90–3.CrossRefPubMed
24.
Yamada Y, Uchida J, Izumi H, et al. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 2014;53:13–9.CrossRefPubMed
25.
Tay J, Luscombe-Marsh ND, Thompson CH, et al. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care. 2014;37:2909–18.CrossRefPubMed
26.
Maiorino MI, Petrizzo M, Bellastella G, Giugliano D, Esposito K, et al. Comment on Tay et al. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care. 2015;38:e64.PubMed
27.
Tay J, Luscombe-Marsh ND, Thompson CH, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015.doi:10.​3945/​ajcn.​115.​112581
28.
Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care. 2012;35:434–45.PubMedCentralCrossRefPubMed
29.
Johnston BC, Kanters S, Bandayrel K, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312:923–33.CrossRefPubMed
30.
Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New Engl J Med. 2009;360:859–73.PubMedCentralCrossRefPubMed
31.
Hite AH, Berkowitz VG, Berkowitz K. Low-carbohydrate diet review: shifting the paradigm. Nutr Clin Pract. 2011;26:300–8.CrossRefPubMed
32.
Foresight. Tackling obesities: future choices—project report. 2nd ed. London: Government Office for Science; 2009.
33.
US Department of Agriculture. A series of systematic reviews on the relationship between dietary patterns and health outcomes. Alexandria: USDA; 2014.
34.
Willett WC, Stampfer MJ. Current evidence on healthy eating. Annu Rev Public Health. 2013;34:77–95.CrossRefPubMed
35.
Seal CJ, Brownlee IA. Whole-grain foods and chronic disease: evidence from epidemiological and intervention studies. Proc Nutr Soc. 2015;11:1–7.
36.
Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013;346:e7492.CrossRef
37.
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98:1084–102.PubMedCentralCrossRefPubMed
38.
O’Connor L, Imamura F, Lentjes MA, Khaw KT, Wareham NJ, Forouhi NG. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia. 2015;58:1474–83.PubMedCentralCrossRefPubMed
39.
Xi B, Huang Y, Reilly KH, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr. 2015;14(113):709–17.CrossRef
40.
Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54.CrossRef
41.
42.
Raynor HA, Anderson AM, Miller GD, Look AHEAD Research Group, et al. Partial meal replacement plan and quality of the diet at 1 year: action for health in diabetes (Look AHEAD) Trial. J Acad Nutr Diet. 2015;115:731–42.CrossRefPubMed
43.
Czyżewska-Majchrzak Ł, Grzelak T, Kramkowska M, Czyżewska K, Witmanowski H. The use of low-carbohydrate diet in type 2 diabetes—benefits and risks. Ann Agric Environ Med. 2014;21:320–6.CrossRefPubMed
44.
Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8:e55030.PubMedCentralCrossRefPubMed
45.
Whitham D. Nutrition for the prevention and treatment of chronic kidney disease in diabetes. Can J Diabetes. 2014;38:344–8.CrossRefPubMed
46.
Tirosh A, Golan R, Harman-Boehm I, et al. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care. 2013;36:2225–32.PubMedCentralCrossRefPubMed
47.
Friedman AN, Ogden LG, Foster GD, et al. Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012;7:1103–11.PubMedCentralCrossRefPubMed
48.
Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate diet vs high-carbohydrate diet. J Am Diet Assoc. 2010;110:633–8.CrossRefPubMed
49.
Bielohuby M, Matsuura M, Herbach N, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats. J Bone Miner Res. 2010;25:275–84.CrossRefPubMed
50.
Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis. 2002;40:265–74.CrossRefPubMed
51.
Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int. 2006;17:1398–403.CrossRefPubMed
52.
Liebman M. When and why carbohydrate restriction can be a viable option. Nutrition. 2014;30:748–54.CrossRefPubMed
53.
54.
Gardner CD, Kim S, Bersamin A, et al. Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study. Am J Clin Nutr. 2010;92:304–12.PubMedCentralCrossRefPubMed
55.
Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67:188–205.CrossRefPubMed
56.
Fardet A, Boirie Y. Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews. Nutr Rev. 2014;72:741–62.CrossRefPubMed
57.
Chowdhury R, Warnakula S, Kunutsor S, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med. 2014;160:398–406.CrossRefPubMed
58.
Harcombe Z, Baker JS, Cooper SM, et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart. 2015;2:e000196.PubMedCentralCrossRefPubMed
59.
Willett WC, Stampfer MJ, Sacks FM. Association of dietary, circulating, and supplement fatty acids with coronary risk. Ann Intern Med. 2014;161:453.CrossRefPubMed
60.
Mann J, McLean R, Te Morenga L. Evidence favours an association between saturated fat intake and coronary heart disease. BMJ. 2013;347:f6851.CrossRefPubMed
61.
United States Department of Health and Human Services and of Agriculture. Scientific report of the 2015 Dietary Guidelines Advisory Committee. USDA; 2015.
62.
Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015;6:CD011737.PubMed
63.
Schwingshackl L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113:1640–61.CrossRefPubMed
64.
FAO. Definition of sustainable diets. International scientific symposium: biodiversity and sustainable diets united against hunger. Rome (Italy): Food and Agriculture Organization of the United Nations; 2010.
65.
Weber CL, Matthews HS. Food-miles and the relative climate impacts of food choices in the United States. Environ Sci Technol. 2008;43:3508–13.CrossRef
66.
Yang W, Lu J, Weng J, for the China National Diabetes and Metabolic Disorders Study Group, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101.CrossRefPubMed
67.
Chan J, Malik V, Jia W, et al. Diabetes in Asia. Epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.CrossRefPubMed
68.
International Diabetes Federation. Diabetes atlas. 6th ed. Brussels: IDF; 2013.
Metadata
Title
Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?
Author
Pamela Dyson
Publication date
01-12-2015
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 4/2015
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-015-0136-9

Other articles of this Issue 4/2015

Diabetes Therapy 4/2015 Go to the issue

Original Research

IDegLira Versus Alternative Intensification Strategies in Patients with Type 2 Diabetes Inadequately Controlled on Basal Insulin Therapy

Erratum

Erratum to: Early Glycemic Response Predicts Achievement of Subsequent Treatment Targets in the Treatment of Type 2 Diabetes: A Post hoc Analysis

Original Research

The Importance of Weight Change Experiences for Performance of Diabetes Self-Care: A Patient-Centered Approach to Evaluating Clinical Outcomes in Type 2 Diabetes

Brief Report

The Effects of Transition from Bedtime to Morning Glargine Administration in Patients with Poorly Regulated Type 1 Diabetes Mellitus: Croatian Pilot Study

Original Research

Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes

Review

Sleep Optimization and Diabetes Control: A Review of the Literature
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits