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

HbA1c decreased by 0.91% in the intervention group (from 7.90% to 6.99%), while the control group showed a non-significant increase of 0.25%. The between-group difference was 1.17% (p<0.001), favoring the intervention.

Fasting glucose decreased by 1.46 mmol/L (15.5%) in the intervention group, while the control group increased by 1.04 mmol/L (12.1%). The between-group difference was significant (p<0.001).

Body weight decreased by 4.35 kg (5.1%) in the intervention group, while the control group gained 2.53 kg (3.3%). The between-group difference was significant (p=0.001).

BMI decreased by 1.63 kg/m² (5.2%) in the intervention group, while the control group increased by 0.96 kg/m² (3.3%). The between-group difference was significant (p=0.001).

Remote nutrition education program based on a low-carbohydrate dietary approach delivered via WhatsApp, educational videos on YouTube, and a digital PDF nutrition guide. Participants limited carbohydrate-rich foods to approximately 4 tablespoons per meal. Program included 9 educational videos (15-50 min), a digital visual nutrition guide, and 48 WhatsApp messages (dietary recommendations, motivational messages, and individual support) over 16 weeks.

Positive: 4; Negative: 0; No effect: 0; Mixed: 0

Extracted 4 outcome signals across the study

Intervention group showed significant improvements across all four measured outcomes (HbA1c, fasting glucose, body weight, BMI) and reduced medication use, while control group showed worsening in most measures

HbA1c ↓ by 0.91% (net difference 1.17% vs control)

Mostly intermediate or surrogate outcomes

Remote nutrition education with low-carb guidance improved glycemic control more than standard primary care alone

Reductions in medication use suggest the intervention may lower treatment burden and healthcare costs

Results were achieved using simple, scalable digital tools (videos, PDF guide, WhatsApp messaging)

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 with no post-intervention follow-up

No quantitative dietary intake or adherence assessment

Baseline imbalances in body weight and HbA1c between groups (not statistically significant)

Single-center study in one Brazilian municipality, limiting generalizability

A 16-week remote nutrition education program based on a low-carbohydrate diet improved HbA1c, fasting glucose, BMI, and reduced medication needs in adults with type 2 diabetes in Brazilian primary care.

The ADA Standards of Care provide evidence-based guidelines for diabetes management including medical nutrition therapy. The nutrition recommendations for type 2 diabetes emphasize individualized eating patterns with carbohydrate management as a key component for glycemic control.

American Diabetes Association Standards of Care in Diabetes—2025: Facilitating Behavior Change and Well-being to Improve Health Outcomes

Brazilian national clinical practice guidelines for diabetes management covering diagnosis, treatment targets, pharmacological and non-pharmacological interventions including dietary approaches appropriate for the Brazilian primary care context and public health system.

Sociedade Brasileira de Diabetes (SBD) Guidelines 2024-2025

The World Health Organization provides a comprehensive overview of diabetes including prevalence, risk factors, complications, and evidence-based strategies for prevention and management relevant to global and public health contexts.

Annual ADA clinical practice guideline issue covering broad diabetes management.

NICE clinical guideline for adult type 2 diabetes management.

NIDDK management overview including self-care strategies.

CDC prevention and diabetes risk-reduction resource.

American Diabetes Association resource matched by keyword relevance (type 2 diabetes)

A Guide for People with Type 2 Diabetes | American Diabetes Association

Type 2 diabetes mellitus (T2DM) is a major global health concern with increasing prevalence and healthcare costs. Despite the availability of pharmacological interventions, sustained glycemic control and disease remission remain challenging. Dietary strategies such as low-carbohydrate diets (LCDs) and ketogenic diets (KDs) are gaining attention for their potential to improve metabolic parameters and induce T2DM remission. The objective of this review is to evaluate the long-term efficacy and safety of low-carbohydrate and ketogenic diets in the management and remission of type 2 diabetes mellitus. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library databases were searched using predefined keywords and filters. Studies included randomized and non-randomized clinical trials published in English within the last 24 years. Eligible studies involved adult T2DM patients on LCDs/KDs with a follow-up period of at least 12 months. The primary outcomes were T2DM remission, changes in glycated hemoglobin (HbA1c), body weight, body mass index (BMI), and secondary outcomes included blood pressure, lipid profiles, and adverse effects. Out of 124 initially identified studies, six studies met the inclusion criteria, with follow-up durations ranging from one to eight years. Low-carbohydrate and ketogenic diets led to significant reductions in HbA1c, body weight, BMI, and systolic blood pressure. In terms of long-term studies, remission rates were highest at one year (up to 62%) and declined to 13% by year five. Participants in the intervention groups also experienced reduced dependency on glucose-lowering and antihypertensive medications. Despite some weight regain and glycemic relapse over time, the overall metabolic improvements suggest a beneficial role of dietary intervention in T2DM management. Low-carbohydrate and ketogenic diets appear to be effective in improving metabolic outcomes and inducing remission in T2DM. These dietary interventions may serve as viable alternatives to pharmacological treatments or bariatric surgery, provided that long-term adherence and support mechanisms are in place. Further research is needed to address long-term safety, sustainability, and individualized dietary approaches.

Long-Term Efficacy and Safety of a Low-Carbohydrate Diet in Type 2 Diabetes Remission: A Systematic Review.

<h4>Background</h4>The dual burden of Type 2 Diabetes Mellitus (T2DM) and obesity is a critical public health issue. Low-carbohydrate diets have emerged as a potential intervention, yet clinical evidence remains inconclusive.<h4>Purpose</h4>This meta-analysis assesses the impact of low-carbohydrate diets on metabolic profiles in overweight or obese T2DM patients, aiming to guide clinical practice.<h4>Methods</h4>A systematic review identified randomized clinical trials (RCTs) comparing low-carbohydrate diets to control diets in T2DM patients from PubMed, Embase, and the Cochrane Library databases up to April 2023.<h4>Results</h4>Seventeen RCTs, encompassing 1,197 participants, demonstrated that low-carbohydrate diets significantly improved HbA1c levels and fasting plasma glucose (mean difference [MD] = -0.36, 95% CI -0.44 to -0.29, <i>p</i> < 0.00001; MD = -10.71, 95% CI -14.39 to -7.03, <i>p</i> < 0.00001). They also reduced triglycerides and increased HDL cholesterol (MD = -19.91, 95% CI -28.83 to -10.99, <i>p</i> < 0.00001; MD = 2.49, 95% CI 1.07-3.91, <i>p</i> = 0.0006), without affecting LDL and total cholesterol. Weight loss, reduced BMI, lower diastolic blood pressure, and decreased waist circumference were additional benefits.<h4>Conclusion</h4>Low-carbohydrate diets may enhance glycemic control and lipid profiles in overweight or obese T2DM patients, warranting consideration in T2DM management. However, the variability in diet definitions and methodologies underscores the necessity for further research to standardize dietary guidelines and evaluate long-term effects.

The effects of low-carbohydrate diet on glucose and lipid metabolism in overweight or obese patients with T2DM: a meta-analysis of randomized controlled trials.

<h4>Introduction</h4>Dietary modification, particularly low-carbohydrate diet, and diabetes self-management education (DSME) have shown promise in improving glycaemic control among persons with type 2 diabetes mellitus (T2DM). However, real-world evidence from India is limited. This protocol describes the methods of a cluster randomised trial to determine the effectiveness and feasibility of adopting a low-carbohydrate diet among persons with T2DM.<h4>Methods and analysis</h4>Our cluster-randomised trial with a mixed-method process evaluation will use computer-generated block randomisation sequence to randomise Urban Primary Health Centres (UPHCs) (n=16) to either continue delivering the usual guideline-based care under the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD) or our study intervention. The study intervention will comprise a personalised nutrition counselling focusing on (i) low-carbohydrate diet (<130 g/day) (ii) diabetes self-management principles. A primary care nurse will deliver the intervention at baseline, 3, 6, 9 and 12 months.We will include persons with T2DM, over the age of 30 years and above, irrespective of comorbidities, registered in the selected UPHC under care for diabetes for at least a month and with an glycated haemoglobin (HbA1c) level ≥6.5% during the screening test. We will collect data electronically using semistructured questionnaires and measure HbA1c, blood pressure, lipid profile, serum creatinine and body weight at baseline, 3, 6, 9 and 12 months after enrolment. We will use a difference in difference analysis, adjusted for clustering, to compare the change in HbA1c at the follow-up visits compared with baseline across the two study arms. We will conduct both intention-to-treat and per-protocol analysis, exploring reasons for differences in effect size.<h4>Ethics and dissemination</h4>The study protocol was reviewed and approved by the Scientific Advisory Committee/Institutional Human Ethics Committee of the research institution (NIE/IHEC/202302-03). The findings of this study will be disseminated through publication in peer-reviewed journals.<h4>Trial registration number</h4>Clinical Trials Registry-India (CTRI/2024/02/062202).

Effectiveness of primary care-led low-carbohydrate diet and self-management advice on glycaemic control in individuals with type 2 diabetes mellitus: protocol of a cluster randomised controlled trial.

<h4>Aim/introduction</h4>To evaluate the therapeutic efficacy short-term continuous subcutaneous insulin infusion (CSII) intensive therapy combined with a low-carbohydrate diet (LCD) for diabetes remission in patients with newly diagnosed type 2 diabetes mellitus.<h4>Materials and methods</h4>This study included patients newly diagnosed with type 2 diabetes mellitus, who were randomly divided into two groups: conventional (conventional CSII + traditional lifestyle guidance); and intensive (intensive CSII + LCD lifestyle guidance). CSII was used for blood glucose control, with continuous glucose monitoring (CGM) used to monitor blood glucose levels. The primary outcome measure was hemoglobin A1c (HbA1c) level; secondary outcomes included body weight, body mass index (BMI), waist circumference, glycemic control, and biochemical indices.<h4>Results</h4>The time in range (TIR) in the intensive treatment group was greater than that in the conventional treatment group (P < 0.05). There was no significant difference in the incidence of hypoglycemia between the two groups (P > 0.05). Compared with the conventional treatment group, diabetes remission rates were significantly greater in the intensive treatment group (P < 0.05). In the intensive treatment group, fasting plasma glucose (FPG), HbA1c, Homeostasis Model assessment of Insulin Resistance (HOMA-IR), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and changes in body weight, BMI, visceral fat area (VFA), and subcutaneous fat area (SFA) decreased significantly (P < 0.05). FPG, HOMA-IR, TG, LDL-c, and changes in body weight, BMI, waist circumference, and VFA were significantly correlated with HbA1c levels (P < 0.05).<h4>Conclusions</h4>The combination of intensive CSII and LCD lifestyle guidance had been improved the remission rate in patients with newly diagnosed type 2 diabetes mellitus.

Diabetes remission in newly diagnosed type 2 diabetes mellitus through short-term continuous subcutaneous insulin infusion intensive therapy combined with low-carbohydrate diet treatment.

<h4>Aims</h4>This study aims to evaluate the efficacy of a low-carbohydrate diet with exercise (LCD + EX) compared to a non-carbohydrate-restricted diet with exercise (NRD + EX) on glycemic control and other clinically relevant metabolic health outcomes in adults with type 2 diabetes mellitus (T2DM).<h4>Materials and methods</h4>A systematic search was conducted across five databases from inception to August 1, 2025. Randomized controlled trials (RCTs) were analysed using random-effects models, with outcomes expressed as mean difference (MD) and 95% confidence intervals (CIs).<h4>Results</h4>Twelve RCTs involving 805 participants were included. No significant differences were observed between LCD + EX and NRD + EX in the overall analysis for glycosylated haemoglobin (MD [95% CI]: -0.18 [-0.43, 0.07] %, p = 0.16), fasting glucose (-0.30 [-0.67, 0.07] mmol/L, p = 0.11), insulin levels (-1.45 [-3.62, 0.73] μIU/mL, p = 0.19), and HOMA-IR (-0.17 [-0.46, 0.11] arbitrary unit, p = 0.23). Additionally, no between-group differences were observed for body composition, blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels. However, changes in high-density lipoprotein cholesterol and triglyceride levels favoured the LCD + EX group. Subgroup analysis for intervention duration ≤6 months revealed a trend of improvement for HbA1c (-0.30 [-0.57, -0.03] %, p = 0.03) and fasting glucose (-0.34 [-0.69, 0.00] mmol/L, p = 0.05) in the LCD + EX group.<h4>Conclusions</h4>LCD + EX did not demonstrate significant overall improvements in glycemic control or body composition compared to NRD + EX in adults with T2DM. However, potential benefits were noted in lipid profiles and in shorter interventions. Future studies can focus on differences in metabolic outcomes among various types of LCD, enabling tailored clinical recommendations.

Efficacy of a low-carbohydrate diet combined with exercise on glycemic control and metabolic health in type 2 diabetes mellitus: A systematic review and meta-analysis.

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 nutrition education with low-carb diet improves blood sugar and reduces medication use in type 2 diabetes

This study tested a remote nutrition education program focused on a low-carbohydrate diet in 58 Brazilian adults with type 2 diabetes. After 16 weeks, those in the program had better blood sugar control, lost weight, and used less diabetes medication compared to those receiving standard care.

The study was open-label (participants knew their group), which may have influenced behaviors beyond the diet itself. The 16-week period is relatively short, and long-term sustainability of these benefits needs further study. Results come from a single Brazilian municipality and may differ in other healthcare contexts.

Remote low-carb nutrition education vs standard care for T2DM

Adults aged 40-89 with non-insulin-treated type 2 diabetes in primary care settings who have internet access and are willing to make dietary changes using digital nutrition education.

Remote nutrition education with low-carb diet improves blood sugar and reduces medication use in type 2 diabetes

Springer

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