Outcomes of a Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program: 1-Year Results of a Single-Arm Longitudinal Study

Abstract

BackgroundType 2 diabetes mellitus has serious health consequences, including blindness, amputation, stroke, and dementia, and its annual global costs are more than US $800 billion. Although typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet.ObjectiveOur objective was to evaluate the 1-year outcomes of the digitally delivered Low-Carb Program, a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring.MethodsThe study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. From adults with type 2 diabetes who had joined the program and had a complete baseline dataset, we randomly selected participants to be followed for 1 year (N=1000; mean age 56.1, SD 15.7 years; 59.30% (593/1000) women; mean glycated hemoglobin A1c (HbA1c) 7.8%, SD 2.1%; mean body weight 89.6 kg, SD 23.1 kg; taking mean 1.2, SD 1.01 diabetes medications).ResultsOf the 1000 study participants, 708 (70.80%) individuals reported outcomes at 12 months, 672 (67.20%) completed at least 40% of the lessons, and 528 (52.80%) completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% (289/714) reduced one or more of these medications. Almost half (46.40%, 464/1000) of all participants lost at least 5% of their body weight. Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% (P<.001) and lost an average of 6.9% of their body weight (P<.001).ConclusionsEspecially for participants who fully engage, an online program that teaches a carbohydrate-reduced diet to adults with type 2 diabetes can be effective for glycemic control, weight loss, and reducing hypoglycemic medications.

An evidence‐based approach to developing low‐carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods

“…Of these, 15/29 used high‐frequency contact (defined as ≥2 sessions/month), 10/29 used moderate‐frequency contact (defined as ≥1 session/month), and 4/29 used low‐frequency contact (defined as <1 session/month). Five (5/40) studies reported the use of remote contact (eg, email, phone, web‐based application, online discussion boards) for the majority or all of the scheduled contact, or as a supplement to in‐person contact . One study offered participants a choice between remote and/or in‐person contact …”

“…Eighteen studies were randomized controlled trials, 17,21-37 three were non-randomized controlled clinical trials, 15,38,39 16 were single-arm intervention studies, 16,[18][19][20][40][41][42][43][44][45][46][47][48][49][50][51] two were retrospective case series analyses, 14,52 and two were case reports. 53,54 Thirty-four studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][32][33][34][36][37][38][43][44][45][46]…”

“…One study specifically reported providing advice on adequate intakes of omega-3 and omega-6 polyunsaturated fats. 39 Nineteen studies (19/40) reported on the types of dietary protein prescribed ( 31,39,51 or as a supplement to in-person contact. 25,39,52 One study offered participants a choice between remote and/or in-person contact.…”

<p>Diet, Diabetes Status, and Personal Experiences of Individuals with Type 2 diabetes Who Self-Selected and Followed a Low Carbohydrate High Fat diet</p>

“…7 More recently, severe carbohydrate restriction has also gained attention due to the potential for T2D remission. 3,8,9 There has been much scientific interest in carbohydrate restricted diets to manage T2D, with at least 22 randomized control trials, 10 non-randomized control trials, and 10 systematic reviews (9 with meta-analyses) that have investigated the effects of carbohydrate restriction on glycemic control in patients with T2D. 10−13 While there is considerable heterogeneity in findings, this evidence generally shows that the lower carbohydrate dietary interventions are at least as effective as control diets for improving HbA1c, T2D medication requirements, body weight, and dyslipidemia.…”

Ernährungsempfehlungen bei Diabetes mellitus (Update 2019)

“…Studien zeigen, dass eine Beratung durch Ernährungsfachkräfte mit einer effektiveren Senkung des HbA1c assoziiert ist [3]. Digitale und qualitätsgesicherte Programmangebote haben ebenfalls das Potential bei einer Ernährungsumstellung zu unterstützen [10].…”