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Can a Low-Carb Diet Reverse T2D?

Jul 31, 2021
Editor: Steve Freed, R.PH., CDE

Author: Shalonda Kimble, PharmD Candidate, South College School of Pharmacy 

Investigating whether a low-carb diet can lead to diabetes remission.

Diabetes is a common disease that affects 1 in 11 adults around the world. It contributes to 11% of deaths yearly. Type two diabetes, the most common type of diabetes, has a distinct feature of insulin resistance, which is driven by chronic hyperglycemia. This is commonly diagnosed by measuring glycemia, having a fasting blood glucose concentration of 128mg/dL. (7.0 mmol/L) or having an HbA1c value of 6.5% or more. Type 2 diabetes is associated with many risk factors from lifestyle influences and genetic factors. The more common factor is obesity. Low carbohydrate diets limit the intake of sugary foods, pasta, and bread, and can help reduce weight in patients and improve several health markers over time. Whole foods such as vegetables and natural proteins are usually consumed. There are several low-carbohydrate diets out there, and many individuals seek advice from their health care provider on which diet would fit their lifestyle best.


Dietary interventions are commonly recommended for patients who have been diagnosed with diabetes or individuals who have a prediabetes status. Lowering the amount of carbohydrates individuals consume has been suggested to improve blood glucose and health outcomes of type 2 diabetes. Structured diets are considered a necessary part of treating diabetes. However, there is uncertainty about which diet would help patients. Previous studies have shown moderate intake of carbohydrates may dilute the effect of low carbohydrate diets. This study systemically assessed the safety, efficacy, and certainty of outcomes for patients diagnosed with type 2 diabetes who participated in low carbohydrate diets.

The study was a systemic review with a meta-analysis of randomized controlled trials. Individuals with or without cardiovascular conditions were included in the study. In addition, trials that compared low carbohydrate diets with or without exercise or lifestyle changes were reviewed. Individuals that participated had to consume less than 26% of calories from carbohydrates, or less than 130 grams per day for 12 weeks or longer in duration. The trials’ primary outcomes were remission of type 2 diabetes, which was defined as having an HbA1c of less than 6.5% or having a fasting glucose level of less than 7.0 mmol/L with or without anti-diabetic therapy. In addition, other outcomes were associated with the quality of life, lab test data, which included cholesterol values such as low-density proteins and total cholesterol values.

Search results were gathered from several database sites. The search yielded a total of 14,759 records; of the studies, 23 met the inclusion criteria. The duration of treatment ranged from three months to two years. Eight of the studies showed remission of diabetes occurred at six months. Low carbohydrate diets were shown to increase remission rates by 32 per 100 patients. (Risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, number of participants = 264). A trend was observed at 12 months for increases in low-density lipoprotein cholesterol. Low carbohydrate diets were shown to improve triglyceride lab values in patients, reduce medication use, and improve weight loss within six months.

One limitation to the study was that the definition of remission of diabetes is up for debate. It was not noted if remission would be seemingly achievable due to different remission definitions about diabetes. Another limitation to the study was the safety concern that was raised with low carbohydrate diets. The outcomes of and serious adverse events were not identified and were poorly reported within the trials. Restricting carbohydrates may lead to worsening one’s quality of life. It may also worsen low-density lipoprotein cholesterol. Clinicians may want to consider short-term low cholesterol diets to help manage type 2 diabetes. This approach will be monitored continuously, and diabetic medication should be adjusted as needed per patient.

Practice  Pearls:

  • Low-carb diets were shown to increase remission rates by 32 per 100 diabetes patients.
  • Low-carb diets have been shown to reduce not only A1c but also decrease triglycerides.
  • Some studies have shown a decrease in HbA1c levels in as little as 6 to 12 months while patients were actively on a low carbohydrate diet


Goldenberg, J., Day, A., Brinkworth, Efficacy, and safety of low and very low carbohydrate diets for type 2 diabetes remission. BMJ, January 13, 2021


Shalonda Kimble, PharmD Candidate, South College School of Pharmacy



See more about low-carb diets and diabetes.