• Jeremy D Krebs, Damon Bell, Rosemary Hall, Amber Parry-Strong, Paul D Docherty, Kristen Clarke, and J Geoffry Chase.
• Endocrine, Diabetes and Research Centre, Wellington Hospital, Wellington, New Zealand. Jeremy.krebs@ccdhb.org.nz
• J Am Coll Nutr. 2013 Jan 1; 32 (1): 11-7.

ObjectiveThe optimal diet for weight loss in type 2 diabetes remains controversial. This study examined a low-carbohydrate, high-fat diet with detailed physiological assessments of insulin sensitivity, glycemic control, and risk factors for cardiovascular disease.MethodsFourteen obese patients (body mass index [BMI] 40.6 ± 4.9 kg/m(2)) with type 2 diabetes were recruited for an "Atkins"-type low-carbohydrate diet. Measurements were made at 0, 12, and 24 weeks of weight, insulin sensitivity, HbA1c, lipids, and blood pressure.ResultsTwelve completers lost a mean of 9.7 ± 1.8 kg over 24 weeks attributable to a major reduction in carbohydrates and resultant reduction in total energy intake. Glycemic control significantly improved (HbA1c -1.1 ± 0.25%) with reductions in hypoglycemic medication. Fasting glucose, homeostasis model assessment (HOMA), and area under the curve (AUC) glucose (intravenous glucose tolerance test [IVGTT]) were significantly reduced by week 12 ( p < 0.05). There were nonsignificant improvements in insulin sensitivity (SI) at week 12 ( p = 0.19) and week 24 ( p = 0.31). Systolic blood pressure was reduced (mean -10.0 mmHg between weeks 0 and 24, p = 0.13). Mean high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol all increased. The ratio of total: HDL cholesterol and triglycerides was reduced.ConclusionA low-carbohydrate diet was well tolerated and achieved weight loss over 24 weeks in subjects with diabetes. Glycemic control improved with a reduction in requirements for hypoglycemic agents.

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