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 .
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 .
An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial
Background Type 2 diabetes is a prevalent , chronic disease for which diet is an integral aspect of treatment . In our previous trial , we found that recommendations to follow a very low-carbohydrate ketogenic diet and to change lifestyle factors ( physical activity , sleep , positive affect , mindfulness ) helped overweight people with type 2 diabetes or prediabetes  improve glycemic control and lose weight . This was an in-person intervention , which could be a barrier for people without the time , flexibility , transportation , social support , and /or financial re sources to attend . Objective The aim was to determine whether an online intervention based on our previous recommendations ( an ad libitum very low-carbohydrate ketogenic diet with lifestyle factors ; “ intervention ” ) or an online diet program based on the American Diabetes Associations ’ “ Create Your Plate ” diet ( “ control ” ) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes . Methods In this pilot feasibility study , we r and omized overweight adults ( body mass index ≥25 ) with type 2 diabetes ( glycated hemoglobin [ HbA1c ] 6.5%-9.0 % ) to a 32-week online intervention based on our previous recommendations ( n=12 ) or an online diet program based around a plate method diet ( n=13 ) to assess the impact of each intervention on glycemic control and other health outcomes . Primary and secondary outcomes were analyzed by mixed-effects linear regression to compare outcomes by group . Results At 32 weeks , participants in the intervention group reduced their HbA1c levels more ( estimated marginal mean [ EMM ] –0.8 % , 95 % CI –1.1 % to –0.6 % ) than participants in the control group ( EMM –0.3 % , 95 % CI –0.6 % to 0.0 % ; P=.002 ) . More than half of the participants in the intervention group ( 6/11 , 55 % ) lowered their HbA1c to less than 6.5 % versus 0 % ( 0/8 ) in the control group ( P=.02 ) . Participants in the intervention group lost more weight ( EMM –12.7 kg , 95 % CI –16.1 to –9.2 kg ) than participants in the control group ( EMM –3.0 kg , 95 % CI –7.3 to 1.3 kg ; P<.001 ) . A greater percentage of participants lost at least 5 % of their body weight in the intervention ( 10/11 , 90 % ) versus the control group ( 2/8 , 29 % ; P=.01 ) . Participants in the intervention group lowered their triglyceride levels ( EMM –60.1 mg/dL , 95 % CI –91.3 to –28.9 mg/dL ) more than participants in the control group ( EMM –6.2 mg/dL , 95 % CI –46.0 to 33.6 mg/dL ; P=.01 ) . Dropout was 8 % ( 1/12 ) and 46 % ( 6/13 ) for the intervention and control groups , respectively ( P=.07 ) . Conclusions Individuals with type 2 diabetes improved their glycemic control and lost more weight after being r and omized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional , low-fat diabetes diet online program . Thus , the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes . Trial Registration Clinical Trials.gov NCT01967992 ; https:// clinical trials.gov/ct2/show/NCT01967992 ( Archived by WebCite at http://www.webcitation.org/6o0fI9Mkq
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 .
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 .