Understanding Artificial Pancreas Systems: Results from a 24-Month Trial

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Open-label or unblinded (moderate): Open-label design

The intervention group achieved a significant mean reduction of 0.91% in HbA1c (from 7.9% to 6.99%, p<0.001), while the control group showed a non-significant increase of 0.25%. The net difference of 1.17% between groups (p<0.001) represents a clinically meaningful improvement associated with reduced cardiovascular events and microvascular complications. Additionally, 31% of intervention participants achieved HbA1c ≤6.5% (diabetes remission range) compared to 0% in the control group.

Fasting glucose decreased significantly in the intervention group by 1.46 mmol/L (-15.5%, from 9.37 to 7.92 mmol/L, p=0.0004), while the control group experienced a significant increase of 1.04 mmol/L (+12.1%, p=0.019). The net difference of 27.5% between groups (p<0.001) demonstrates strong glycemic improvement with the intervention.

The intervention group achieved significant weight loss of 4.35 kg (-5.1%, from 85.2 to 80.9 kg, p<0.001), while the control group gained 2.53 kg (+3.3%, p=0.0002). The net difference of 8.4% between groups (p=0.001) represents meaningful weight reduction that likely contributed to improved insulin sensitivity and metabolic health.

BMI decreased significantly by 1.63 kg/m² (-5.2%, from 31.4 to 29.7 kg/m², p<0.001) in the intervention group, while increasing by 0.96 kg/m² (+3.3%, p=0.0002) in the control group. The net difference of 8.5% between groups (p=0.001) demonstrates substantial anthropometric improvement.

In the intervention group, 44.8% of participants reduced or discontinued oral antidiabetic medications (20.7% reduced dose, 24.1% discontinued entirely), while 0% in the control group reduced medications (p<0.001). Conversely, 34.4% of control group participants required medication additions or dose increases compared to 0% in the intervention group (p<0.001), demonstrating the intervention's ability to reduce pharmacological dependence.

16-week remote nutrition education program delivered via WhatsApp, including 9 educational videos (15-50 min each) covering diabetes pathophysiology, macronutrients, practical low-carb meal planning, and food label reading. Participants received 3 messages/week with dietary recommendations, motivation, and individualized nutritionist feedback. Low-carb approach limited carbohydrate-rich foods to approximately 4 tablespoons per meal using familiar household measures.

Positive: 5; Negative: 0; No effect: 0; Mixed: 0

Extracted 5 outcome signals across the study

All primary and secondary outcomes showed strong positive effects in the intervention group with statistical significance (p<0.001 for most outcomes). Intervention group achieved HbA1c reduction of 0.91%, fasting glucose reduction of 15.5%, weight loss of 5.1%, and 44.8% medication reduction, while control group showed worsening of glycemic markers and weight gain. No mixed or negative outcomes reported.

↓ HbA1c by 0.91% (intervention) vs ↑ 0.25% (control)

↓ Fasting glucose by 15.5% (intervention) vs ↑ 12.1% (control)

Remote nutrition education via WhatsApp can deliver clinically meaningful improvements in glycemic control comparable to intensive in-person interventions

Low-carbohydrate dietary approach combined with ongoing professional support enables significant medication reduction in nearly half of participants within 16 weeks

Standard primary care management without structured nutrition support may be insufficient to prevent metabolic deterioration in type 2 diabetes patients

Balbinot GS, Costódio RS, Vicentini GE. Impact of a remote nutrition education on low-carbohydrate diet based in type 2 diabetes management: findings from a Brazilian primary care randomized controlled trial. Diabetol Int. 2026;17(3):42. doi:10.1007/s13340-026-00898-2

Short 16-week duration limits understanding of long-term sustainability and whether remission can be maintained

No dietary intake assessment to confirm adherence to low-carbohydrate recommendations

Baseline imbalances (intervention group had higher weight and slightly lower HbA1c) may have influenced magnitude of improvements

Single-center study in Brazilian primary care limits generalizability to other healthcare systems and populations

A 16-week remote nutrition education program teaching a low-carbohydrate diet via WhatsApp reduced HbA1c by 0.91%, lowered fasting glucose by 15.5%, and enabled 45% of participants to reduce or stop diabetes medications.

↓ Body weight by 5.1% (intervention) vs ↑ 3.3% (control)

45% reduced or stopped diabetes medications (intervention) vs 0% (control)

Limited population scope (moderate): Narrow population scope

Limited safety reporting (moderate): Safety reporting depth: not_reported

No post-intervention follow-up (moderate): 0 weeks of follow-up after treatment ended

Open-label or unblinded study (moderate): Open-label design

Remote low-carb diet education reduces HbA1c by 0.91% and cuts medication use in half for type 2 diabetes

Researchers tested an online nutrition education program delivered through WhatsApp that taught people with type 2 diabetes how to follow a low-carbohydrate diet. After 16 weeks, participants who received the education had much better blood sugar control, lost weight, and nearly half were able to reduce or stop their diabetes medications compared to those receiving standard care.

Intervention was delivered entirely in Portuguese through WhatsApp, requiring smartphone access and literacy

The low-carbohydrate approach used practical household measures (approximately 4 tablespoons carbs per meal) rather than strict gram counting

Medication changes were made by patients' treating physicians based on clinical practice, not a study protocol

Control group experienced worsening glycemic control, which may reflect limitations of conventional primary care rather than natural disease progression

Study was conducted in Brazil's public healthcare system where nutritionists are not stationed at every primary care unit

Remote nutrition education on low-carbohydrate diet for adults with type 2 diabetes in Brazilian primary care

Adults with type 2 diabetes not using insulin (average age 61 years)

Patients with baseline HbA1c ≥6.5% who have access to smartphones and internet

Individuals receiving primary care management seeking alternatives to medication escalation

People able to read and understand Portuguese (similar language accessibility needed for other populations)

Remote low-carb diet education reduces HbA1c by 0.91% and cuts medication use in half for type 2 diabetes

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