Normalization of HbA1c Following an Ad-Libitum, Non-Ketogenic Low Carbohydrate Diet Along With Antidiabetic Agents

Background and Aims: Recent scientific research has found that remission of T2DM can be achieved with substantial weight loss following hypocaloric diet or bariatric surgery. The DiRECT study has shown that after 12 months of dietary management, almost half of participants achieved remission to a non-diabetic state and off antidiabetic drugs. The aim of our study was to investigate the impact of an ad-libitum, low carbohydrate non-ketogenic diet (LCNK) on T2DM control and weight loss of patients reporting to our clinic. Materials and Methods: We reviewed the medical charts of 131 T2DM patients (60% male) who were not receiving insulin; the average number of years with T2DM was 8.4years, mean age was 52.8±1.0 years, mean HbA1c was 8.4±0.1 %, and mean BMI was 32.7±0.6 kg/m2. We instructed patients on an ad-libitum LCNK diet providing 130 - 150g of carbohydrate/day coupled with combination therapy of Metformin and any of the currently available antidiabetic drugs (except those known to induce weight gain). Those on sulfonylurea or glitazones had their doses tapered down and eventually discontinued. Results: All patients came for a first follow up visit within 3 months of being instructed on the diet. Significant weight loss was observed in these patients (91.5±1.7 vs. 85.6±1.5 Kg, p<0.001); equivalent to a 6% decrease in weight. An A1C level below 6.5 % was observed in 60% of our patients who came for a first follow-up visit and it correlated with weight loss. Given that 10% of our population gained weight due to poor adherence to the diet; A1C below 6.5 % was achieved in 50% of our 42 patients who lost between 0-5kg, and in 60% of those who lost between 5-10kg (48 patients), and in 63% of those who lost 10-15kg (19 patients), and in 100% of those who lost more than 15kg (4 patients). We observed in them significant decreases in FBS, cholesterol, LDL, TG, and SGPT. Of the 131 patients, 59 came for a second follow-up visit within 7.5 months and an even more significant weight loss was observed (92.0±2.6 vs. 83.8±2.0 Kg, p<0.001); equivalent to a 9 % decrease. An A1C level below 6.5 % was observed in 63% of patients who came for a second follow-up visit. Given that 14% of the 59 gained weight; A1C below 6.5 % was achieved in 42% of our 12 patients who lost between 0-5kg, and in 61% of those who lost between 5-10kg (19 patients), and in 57% of those who lost 10-15kg (8 patients), and in 90% of those who lost more than 15kg (11 patients). Antidiabetic agents were in general progressively decreased and adjusted to individual needs. At the end 27% were only on metformin. Conclusion: A LCNK diet is easy to prescribe and easily followed by T2D patients (no calorie restriction or counting). We recommend its use especially in the primary care setting because it brings diabetes under immediate control by lowering A1C levels below 6.5% in more than 60% of patients as shown by our results, as well as inducing significant weight loss.