Remission of T2DM has been shown to be possible with dietary modifications and significant weight loss in clinical trials as well as real-world studies (1,2). Low-Carbohydrate Diets (LCDs; <130 g carbohydrates/d(3)) have been shown to be effective in inducing T2DM remission(2). However, there is limited evidence of adherence to a LCD and exploration on blood lipid levels in the context of maintaining long-term remission, outside of clinical trials. The aim of this study was to evaluate the change in dietary intake, HbA1c, weight and blood lipids during 6-months of post remission while following a LCD.
Participants who recently induced T2DM remission were recruited from two GP clinics in England after receiving advice to follow an LCD. Four-day food diaries, weight, and blood parameters (i.e., HbA1c and blood lipids) were collected at baseline, 3-months and 6- months. Dietary intake analyses and statistical analyses were conducted using NutriticsTMand SPSS 29.0, respectively. A repeated measures ANOVA test was conducted to see any significant differences between timepoints. Ethical approval was granted from the Health Research Ethics Committee at Edge Hill University and the NHS (ETH2122- 0228 and 22/SC/045, respectively).
Twelve participants (4 female/8 male) completed the study. Mean (± SD) age of participants was 69 ± 8 years. Duration of T2DM prior to remission was 66 ± 54 months. There were no statistically significant changes in HbA1c level across time points (p>0.05). At 6-months, all participants had HbA1c ≤ 48mmol/mol, indicating maintenance of remission. No statistically significant changes were observed in blood lipids except for HDL-C, which improved from baseline to 6 months (+0.17 mmol/L [95% CI, -0.31 to -0.02], p=0.019). A statistically significant weight loss was observed between baseline and 3- months (-3.6 kg [95% CI, 0.5 to 6.6], p=0.02) and baseline and 6-months (-3.7 kg [95% CI, 0.3 to 7.1], p=0.03). There were no significant changes in carbohydrate intake over time.
However, two participants’ carbohydrate intake exceeded 130 g per day at both baseline and 3-months while 3 participants exceed 130 g at 6 months, indicating a trend of increasing carbohydrate intake with time. While energy intake did not change significantly, it was reported to fall below the DRVs according to sex and age group. At all timepoints, fibre intake was found to be below the recommended 30 g per day.
This study showed that people with newly induced T2DM remission can maintain it over 6 months in a real-world setting, with observed metabolic improvements. Adherence to a LCD was also shown to be possible, although a consistent low fibre intake was observed. Therefore, supporting people in achieving and maintaining T2DM remission through a well-planned diet within primary care could bring about significant benefits if scaled to a population level.