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Old Thu, Jan-14-21, 01:44
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Demi Demi is offline
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Default Low carb diet may be short term alternative to meds for diabetics

Quote:
Low-carb diet could help fight type 2 diabetes

A low-carbohydrate diet can help to put type 2 diabetes into temporary remission, a study has found.

The research, published in the British Medical Journal, is further evidence that changes to diet may be a short-term alternative to medication for the millions of Britons living with the most common form of the condition.

The charity Diabetes UK estimates that more than four million people in the UK have type 2 diabetes, many of them without realising it. While there is no cure, keeping blood sugar levels at a healthy level through diet has long been a recommended treatment.

But there has also been confusion, with some doctors recommending both low-carb and low-fat diets.

A team of international researchers analysed data from 23 trials involving 1,357 people to assess the effectiveness and safety of low-carb diets and very low-carb diets compared with mostly low-fat control diets.

Low-carb diets were defined as less than 26 per cent of daily calories from foods such as bread, rice and pasta, with diets containing less than 10 per cent of calories from the same foods considered very low-carb.

After 6 and 12 months, many of the 1,357 participants showed remission of diabetes, meaning blood sugar had returned to healthy levels, as well as weight loss. The researchers found that patients on low-carb diets achieved higher remission rates at six months compared with patients on control diets, and had no other arising problems.

Eight of the trials, involving a total of 264 participants, showed that eating a small amount of carbohydrates each day cut risks from diabetes at six months by 32 per cent. But researchers also warned that following the low-carb diet for 12 months and longer may do more harm than good, and even increase mortality rates.

Dr Bradley Johnston, associate professor at Texas A&M University’s department of nutrition, said: “Moderate to low certainty evidence suggests that patients adhering to low-carbohydrate diets [LCDs] for six months may experience greater rates of remission of diabetes without adverse consequences compared with other diets commonly recommended for management of type 2 diabetes [for example, low-fat diets].

“These benefits diminished at 12 months, and, although LCDs seem to improve triglycerides [fatty acids combined with glycerol] in a clinical meaningful way, some evidence shows clinical worsening of quality of life and low density lipoprotein cholesterol. Clinicians might consider short-term LCDs for management of type 2 diabetes, while actively monitoring and adjusting diabetes medication as needed.”

Type 2 diabetes is a cause of premature death for about 22,000 people each year in England.


https://www.thetimes.co.uk/edition/...betes-fbrxpsczt

Quote:
Research

Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data


BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4743 (Published 13 January 2021)

Abstract

Objective
To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes.

Design Systematic review and meta-analysis.

Data sources Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020.

Study selection Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible.

Data extraction Primary outcomes were remission of diabetes (HbA1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA1c, fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist.

Results Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I2=58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months.

Conclusions On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs.




https://www.bmj.com/content/372/bmj.m4743
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