Skip to main content

10-07-2015 | Diet | Review | Article

Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence?

Journal: Diabetes Therapy

Author: Pamela Dyson

Publisher: Springer Healthcare



Low carbohydrate diets are again in the spotlight and have been identified as particularly appropriate for people with type 2 diabetes. There is confusion amongst both health professionals and people with diabetes about the suitability of these diets. This review aims to provide an overview of the latest evidence and to explore the role of low carbohydrate diets for people with type 2 diabetes.


An electronic search of English language articles was performed using MEDLINE (2010–May 2015), EMBASE (2010–May 2015), and the Cochrane Central Register of Controlled Trials (2010–May 2015). Only randomized controlled trials comparing interventions evaluating reduced carbohydrate intake with higher carbohydrate intake in people with diagnosed type 2 diabetes were included. Primary outcomes included weight, glycated hemoglobin, and lipid concentrations.


Low carbohydrate diets in people with type 2 diabetes were effective for short-term improvements in glycemic control, weight loss, and cardiovascular risk, but this was not sustained over the longer term. Overall, low carbohydrate diets failed to show superiority over higher carbohydrate intakes for any of the measures evaluated including weight loss, glycemic control, lipid concentrations, blood pressure, and compliance with treatment.


Recent studies suggest that low carbohydrate diets appear to be safe and effective over the short term, but show no statistical differences from control diets with higher carbohydrate content and cannot be recommended as the default treatment for people with type 2 diabetes.
Tattersall B. Diabetes: the biography. Oxford: Oxford University Press; 2009.
Moran M. The evolution of the nutritional management of diabetes. Proc Nutr Soc. 2004;63:615–20. CrossRefPubMed
Sawyer L, Gale EAM. Diet, delusion and diabetes. Diabetologia. 2009;52:1–7. CrossRefPubMed
Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31:1–13. CrossRefPubMed
Dyson PA, Kelly T, Deakin T, on behalf of Diabetes UK Nutrition Working Group, et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2011;28:1282–8. CrossRefPubMed
Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37:S120–43. CrossRefPubMed
Dyson P. A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes. J Hum Nutr Diet. 2008;21:530–8. CrossRefPubMed
Kirk JK, Graves DE, Craven TE, Lipkin EW, Austin M, Margolis KL. Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis. J Am Diet Assoc. 2008;108:91–100. CrossRefPubMed
Castañeda-González LM, Bacardí Gascón M, Jiménez Cruz A. Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks. Nutr Hosp. 2011;26:1270–6. PubMed
Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014;9:e100652. PubMedCentralCrossRefPubMed
VanItallie TB, Nufert TH. Ketones: metabolism’s ugly duckling. Nutr Rev. 2003;61:327–41. CrossRefPubMed
Adam-Perrot A, Clifton P, Bronus F. Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev. 2006;7(1):49–58. CrossRefPubMed
Atkins RC. Dr Atkins new diet revolution. New York: Avon Books, HarperCollins; 2003.
Sears B. The zone: a dietary road map. New York: HarperCollins; 1995.
Agatston A. The South Beach Diet. New York: St Martin’s Press; 2003.
Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97:505–16. CrossRefPubMed
Mann JI, Te Morenga L. Diet and diabetes revisited, yet again. Am J Clin Nutr. 2013;97:453–4. CrossRefPubMed
Iqbal N, Vetter ML, Moore RH, et al. Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants. Obesity. 2010;18:1733–8. CrossRefPubMed
Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010;12:204–9. CrossRefPubMed
Larsen RN, Mann NJ, Maclean E, Shaw JE. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial. Diabetologia. 2011;54:731–40. CrossRefPubMed
Guldbrand H, Dizdar B, Bunjaku B, et al. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia. 2012;55:2118–27. PubMedCentralCrossRefPubMed
Krebs JD, Bell D, Hall R, et al. Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes. J Am Coll Nutr. 2013;32:11–7. CrossRefPubMed
Mayer SB, Jeffreys AS, Olsen MK, McDuffie JR, Feinglos MN, Yancy WS Jr. Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes. Diabetes Obes Metab. 2014;16:90–3. CrossRefPubMed
Yamada Y, Uchida J, Izumi H, et al. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 2014;53:13–9. CrossRefPubMed
Tay J, Luscombe-Marsh ND, Thompson CH, et al. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care. 2014;37:2909–18. CrossRefPubMed
Maiorino MI, Petrizzo M, Bellastella G, Giugliano D, Esposito K, et al. Comment on Tay et al. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care. 2015;38:e64. PubMed
Tay J, Luscombe-Marsh ND, Thompson CH, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015.doi: 10.​3945/​ajcn.​115.​112581
Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care. 2012;35:434–45. PubMedCentralCrossRefPubMed
Johnston BC, Kanters S, Bandayrel K, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312:923–33. CrossRefPubMed
Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New Engl J Med. 2009;360:859–73. PubMedCentralCrossRefPubMed
Hite AH, Berkowitz VG, Berkowitz K. Low-carbohydrate diet review: shifting the paradigm. Nutr Clin Pract. 2011;26:300–8. CrossRefPubMed
Foresight. Tackling obesities: future choices—project report. 2nd ed. London: Government Office for Science; 2009.
US Department of Agriculture. A series of systematic reviews on the relationship between dietary patterns and health outcomes. Alexandria: USDA; 2014.
Willett WC, Stampfer MJ. Current evidence on healthy eating. Annu Rev Public Health. 2013;34:77–95. CrossRefPubMed
Seal CJ, Brownlee IA. Whole-grain foods and chronic disease: evidence from epidemiological and intervention studies. Proc Nutr Soc. 2015;11:1–7.
Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ. 2013;346:e7492. CrossRef
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98:1084–102. PubMedCentralCrossRefPubMed
O’Connor L, Imamura F, Lentjes MA, Khaw KT, Wareham NJ, Forouhi NG. Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages. Diabetologia. 2015;58:1474–83. PubMedCentralCrossRefPubMed
Xi B, Huang Y, Reilly KH, et al. Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis. Br J Nutr. 2015;14(113):709–17. CrossRef
Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54. CrossRef
Wing RR, Look AHEAD Research Group. Implications of Look AHEAD for clinical trials and clinical practice. Diabetes Obes Metab. 2014;16:1183–91. PubMedCentralCrossRefPubMed
Raynor HA, Anderson AM, Miller GD, Look AHEAD Research Group, et al. Partial meal replacement plan and quality of the diet at 1 year: action for health in diabetes (Look AHEAD) Trial. J Acad Nutr Diet. 2015;115:731–42. CrossRefPubMed
Czyżewska-Majchrzak Ł, Grzelak T, Kramkowska M, Czyżewska K, Witmanowski H. The use of low-carbohydrate diet in type 2 diabetes—benefits and risks. Ann Agric Environ Med. 2014;21:320–6. CrossRefPubMed
Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013;8:e55030. PubMedCentralCrossRefPubMed
Whitham D. Nutrition for the prevention and treatment of chronic kidney disease in diabetes. Can J Diabetes. 2014;38:344–8. CrossRefPubMed
Tirosh A, Golan R, Harman-Boehm I, et al. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care. 2013;36:2225–32. PubMedCentralCrossRefPubMed
Friedman AN, Ogden LG, Foster GD, et al. Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012;7:1103–11. PubMedCentralCrossRefPubMed
Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate diet vs high-carbohydrate diet. J Am Diet Assoc. 2010;110:633–8. CrossRefPubMed
Bielohuby M, Matsuura M, Herbach N, et al. Short-term exposure to low-carbohydrate, high-fat diets induces low bone mineral density and reduces bone formation in rats. J Bone Miner Res. 2010;25:275–84. CrossRefPubMed
Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY. Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis. 2002;40:265–74. CrossRefPubMed
Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int. 2006;17:1398–403. CrossRefPubMed
Liebman M. When and why carbohydrate restriction can be a viable option. Nutrition. 2014;30:748–54. CrossRefPubMed
Calton J. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. 2010;7:24. PubMedCentralCrossRefPubMed
Gardner CD, Kim S, Bersamin A, et al. Micronutrient quality of weight-loss diets that focus on macronutrients: results from the A TO Z study. Am J Clin Nutr. 2010;92:304–12. PubMedCentralCrossRefPubMed
Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009;67:188–205. CrossRefPubMed
Fardet A, Boirie Y. Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews. Nutr Rev. 2014;72:741–62. CrossRefPubMed
Chowdhury R, Warnakula S, Kunutsor S, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med. 2014;160:398–406. CrossRefPubMed
Harcombe Z, Baker JS, Cooper SM, et al. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart. 2015;2:e000196. PubMedCentralCrossRefPubMed
Willett WC, Stampfer MJ, Sacks FM. Association of dietary, circulating, and supplement fatty acids with coronary risk. Ann Intern Med. 2014;161:453. CrossRefPubMed
Mann J, McLean R, Te Morenga L. Evidence favours an association between saturated fat intake and coronary heart disease. BMJ. 2013;347:f6851. CrossRefPubMed
United States Department of Health and Human Services and of Agriculture. Scientific report of the 2015 Dietary Guidelines Advisory Committee. USDA; 2015.
Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015;6:CD011737. PubMed
Schwingshackl L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113:1640–61. CrossRefPubMed
FAO. Definition of sustainable diets. International scientific symposium: biodiversity and sustainable diets united against hunger. Rome (Italy): Food and Agriculture Organization of the United Nations; 2010.
Weber CL, Matthews HS. Food-miles and the relative climate impacts of food choices in the United States. Environ Sci Technol. 2008;43:3508–13. CrossRef
Yang W, Lu J, Weng J, for the China National Diabetes and Metabolic Disorders Study Group, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101. CrossRefPubMed
Chan J, Malik V, Jia W, et al. Diabetes in Asia. Epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40. CrossRefPubMed
International Diabetes Federation. Diabetes atlas. 6th ed. Brussels: IDF; 2013.

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »