The team of researchers analyzed 23 randomized trials involving 1,357 participants. A low-carb diet (LCD) was defined as less than 26% daily calories from carbohydrates, and a very low-carb diet (VLCD) was defined as less than 10% daily calories from carbohydrates. Outcomes were reported at six and 12 months and included remission of diabetes, as measured by reduced blood sugar levels with or without the use of diabetes medication; weight loss; adverse events; and health-related quality of life.
Based on low to moderate certainty evidence, the researchers found that those on LCDs achieved higher diabetes remission rates at six months compared with patients on control diets. For example, evidence from 8 trials with 264 participants showed that those following a LCD experienced a 32% absolute risk reduction in diabetes remission at six months—there were 28 fewer cases per 100 followed. LCDs also increased weight loss, reduced medication use, and improved body fat concentrations at six months.
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However, key to success here is the diet’s short-term nature: Most benefits diminished at 12 months, and some studies on this topic have shown a worsening of quality of life and cholesterol levels at that time.The authors acknowledged that there is uncertainty over the long term effectiveness and safety of LCDs, and stressed that their results are based on low to moderate certainty evidence.
They conclude: “Future long term, well designed, calorie controlled randomized trials are needed to determine the effects of LCD on sustained weight loss and remission of diabetes, as well as cardiovascular mortality and major morbidity.”
