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Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort
  1. Shabina Roohi Ahmed1,2,
  2. Sridevi Bellamkonda3,4,
  3. Mihail Zilbermint1,5,
  4. Jiangxia Wang6,
  5. Rita Rastogi Kalyani1
  1. 1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Endocrinology, Johns Hopkins Community Physicians, Bethesda, Maryland, USA
  3. 3Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Internal Medicine, Johns Hopkins Community Physicians, Germantown, Maryland, USA
  5. 5Endocrinology, Diabetes and Metabolism, Johns Hopkins Community Physicians Suburban Hospital, Suburban Hospital, Bethesda, Maryland, USA
  6. 6Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Shabina Roohi Ahmed; Shabina.r.ahmed{at}


Objective The optimal diet to improve glycemia in patients with type 2 diabetes remains unclear. Low carbohydrate, high fat (LCHF) diets can improve glycemic control, but have not been investigated in real-world settings.

Research design and methods We investigated effects of the LCHF diet compared with usual care in a community-based cohort of patients with type 2 diabetes by performing a retrospective study of 49 patients who followed the LCHF diet for ≥3 months, and compared glycemic outcomes with age-matched and body mass index (BMI)-matched controls who received usual care (n=75). The primary outcome was change in A1C from baseline to the end of follow-up.

Results Compared with the usual care group, the LCHF group showed a significantly greater reduction in A1C (−1.29% (95% CI −1.75 to −0.82; p<0.001)) and body weight (−12.8 kg (95% CI −14.7 to −10.8; p<0.001) at the end of follow-up after adjusting for age, sex, baseline A1C, BMI, baseline insulin dose. Of the patients initially taking insulin therapy in the LCHF group, 100% discontinued it or had a reduction in dose, compared with 23.1% in the usual care group (p<0.001). The LCHF group also had significantly greater reduction in fasting plasma glucose (−43.5 vs −8.5 mg/mL; p=0.03) compared with usual care.

Conclusions In a community-based cohort of type 2 diabetes, the LCHF diet was associated with superior A1C reduction, greater weight loss and significantly more patients discontinuing or reducing antihyperglycemic therapies suggesting that the LCHF diet may be a metabolically favorable option in the dietary management of type 2 diabetes.

  • type 2 diabetes
  • nutritional management
  • dietary intervention

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  • Contributors SRA, MZ, SB, JW and RRK were responsible for study concept and design, analysis and interpretation of the data, and drafting and critical revision of the manuscript for important intellectual content. SRA and JW are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The clinical data coordination and retrieval from the Core for Clinical Research Data Acquisition (CCDA) was supported in part by the Johns Hopkins Institute for Clinical and Translational Research (UL1TR001079) and the Epic Scholars Faculty Programme. RRK was supported by the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (NIH/NIDDK) grant R03-DK109163.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional review board of the Johns Hopkins University School of Medicine and Johns Hopkins Community Physicians.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available on reasonable request.

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