Use of low-carbohydrate diets in patients with type 2 diabetes
More details
Hide details
Department of Environmental Medicine and Epidemiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
Department of Human Nutrition, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
Corresponding author
Elżbieta Szczepańska   

Department of Human Nutrition, School of Public Health in Bytom, Medical University of Silesia, Katowice, ul. Jordana 19, 41-808 Zabrze, Poland
Ann. Acad. Med. Siles. 2018;72:287-293
The treatment of type 2 diabetes should be supported with a proper diet paired with physical activity at every stage of therapy. Carbohydrates are key macronutrients with a direct effect on the level of postprandial glycaemia. For the past several decades, dietary intervention studies investigating and comparing the effects of limiting carbohydrate intake in favour of other macronutrients have been carried out. A low-carbohydrate diet has been and still is suggested by some experts as well as patient organizations as the most effective option that is associated with the smallest risk of side effects. The recommendations, however, have not been supported with evidence from high quality randomized control trials. The aim of this work is to review the published meta-analyses of randomized control trials, which compared the parameters relevant for the treatment of diabetes, including fasting plasma glucose, glycated haemoglobin, the lipid profile and weight loss. Currently, there is insufficient scientific evidence allowing a uniform recommendation to be made regarding the optimum amount of carbohydrates in the daily diet, hence the relevant recommendations should be tailored to each patient. In dietary interventions among type 2 diabetes, lowering the patient’s diet energy content is of primary importance, as well as the quality of ingested macronutrients, especially carbohydrates and fats.
2017 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clin. Diabet. 2017; 6(Suppl. A): A9–A19, doi: 10.5603/DK.2017.0001.
Mann J.I., De Leeuw I., Hermansen K., Karamanos B, Karlström B., Katsilambros N., Riccardi G., Rivellese A.A., Rizkalla S., Slama G., Toeller M., Uusitupa M., Vessby B. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr. Metab. Cardiovasc. Dis. 2004; 14(6): 373–394.
Dyson P.A., Kelly T., Deakin T., Duncan A., Frost G., Harrison Z., Khatri D., Kunka D., McArdle P., Mellor D., Oliver L., Worth J. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet. Med. 2011; 28(11): 1282–1288, doi: 10.1111/j.1464-5491.2011.03371.x.
Dämon S., Schätzer M., Höfler J., Tomasec G., Hoppichler F. Nutrition and diabetes mellitus: an overview of the current evidence. Wien. Med. Wochenschr. 2011; 161(11–12): 282–288, doi: 10.1007/s10354-011-0888-4.
American Diabetes Association. 7. Obesity Management for the Treatment of Type 2 Diabetes. Diabetes Care 2017; 40(Suppl. 1): S57-S63, doi: 10.2337/dc17-S010.
Traczyk I., Jarosz M. Węglowodany. W: Normy żywienia dla populacji polskiej – nowelizacja. Red. M. Jarosz. Instytut Żywności i Żywienia. Warszawa 2012, s. 63–74.
Cichon R., Wądołowska L. Węglowodany. W: Żywienie człowieka. Podstawy nauki o żywieniu. Red. J. Gawęcki. PWN. Warszawa 2012, s. 155––180.
Kunachowicz H., Wojtasik A. Błonnik pokarmowy (włókno pokarmowe). W: Normy żywienia dla populacji polskiej – nowelizacja. Red. M. Jarosz. Instytut Żywności i Żywienia. Warszawa 2012, s. 75–85.
Weickert M.O., Pfeiffer A.F. Metabolic effects of dietary fiber consumption and prevention of diabetes. J. Nutr. 2008; 138(3): 439–442.
Jung C.H., Choi K.M. Impact of High-Carbohydrate Diet on Metabolic Parameters in Patients with Type 2 Diabetes. Nutrients 2017; 9(4): 322, doi: 10.3390/nu9040322.
Saslow L.R., Kim S., Daubenmier J.J., Moskowitz J.T., Phinney S.D., Goldman V., Murphy E.J., Cox R.M., Moran P., Hecht F.M. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohy drate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One 2014; 9(4): e91027, doi: 10.1371/journal.pone.0091027.
Krebs J.D., Bell D., Hall R., Parry-Strong A., Docherty P.D., Clarke K., Chase J.G. 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(1): 11–17, doi: 10.1080/07315724.2013.767630.
Tay J., Luscombe-Marsh N.D., Thompson C.H., Noakes M., Buckley J.D., Wittert G.A., Yancy W.S. Jr, Brinkworth G.D. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am. J. Clin. Nutr. 2015; 102(4): 780–790, doi: 10.3945/ajcn.115.112581.
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(2): 320–326, doi: 10.5604/1232-1966.1108597.
Beisswenger B.G., Delucia E.M., Lapoint N., Sanford R.J., Beisswenger P.J. Ketosis leads to increased methylglyoxal production on the Atkins diet. Ann. N. Y. Acad. Sci. 2005; 1043: 201–210.
Shamsaldeen Y.A., Mackenzie L.S., Lione L.A., Benham C.D. Methylglyoxal, a metabolite increased in diabetes is associated with insulin resistance, vascular dysfunction and neuropathies. Curr. Drug Metab. 2016; 17(4): 359–367.
Brouns F. Overweight and diabetes prevention: is a low-carbohydrate-high-fat diet recommendable? Eur. J. Nutr. 2018; 57(4): 1301–1312, doi: 10.1007/s00394-018-1636-y.
Feinman R.D., Pogozelski W.K., Astrup A., Bernstein R.K., Fine E.J., Westman E.C., Accurso A., Frassetto L., Gower B.A., McFarlane S.I., Nielsen J.V. et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015; 31(1): 1–13, doi: 10.1016/j.nut.2014.06.011.
19. – the global diabetes community [online] [Dostęp: 17.07.2017].
van Wyk H.J., Davis R.E., Davies J.S. A critical review of low-carbohydrate diets in people with type 2 diabetes. Diabet. Med. 2016; 33(2): 148–157, doi: 10.1111/dme.12964.
Snorgaard O., Poulsen G.M., Andersen H.K., Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res. Care 2017; 5(1): e000354, doi: 10.1136/bmjdrc-2016-000354.
Tay J., Luscombe-Marsh N.D., Thompson C.H., Noakes M., Buckley J.D., Wittert G.A., Yancy W.S. Jr, Brinkworth G.D. A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial. Diabetes Care 2014; 37(11): 2909–2918, doi: 10.2337/dc14-0845.
Davis N.J., Tomuta N., Schechter C., Isasi C.R., Segal-Isaacson C.J., Stein D., Zonszein J., Wylie-Rosett J. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care 2009; 32(7): 1147–1152, doi: 10.2337/dc08-2108.
Guldbrand H., Dizdar B., Bunjaku B., Lindström T., Bachrach-Lindström M., Fredrikson M., Ostgren C.J., Nystrom F.H. 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(8): 2118–2127, doi: 10.1007/s00125-012-2567-4.
Larsen R.N., Mann N.J., Maclean E., Shaw J.E. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial. Diabetologia 2011; 54(4): 731–740, doi: 10.1007/s00125-010-2027-y.
Yamada Y., Uchida J., Izumi H., Tsukamoto Y., Inoue G., Watanabe Y., Irie J., Yamada S. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern. Med. 2014; 53(1): 13–19.
Ley S.H., Hamdy O., Mohan V., Hu F.B. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet 2014; 383(9933): 1999–2007, doi: 10.1016/S0140-6736(14)60613-9.
Silva F.M., Kramer C.K., de Almeida J.C., Steemburgo T., Gross J.L., Azevedo M.J. Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Nutr. Rev. 2013; 71(12): 790–801, doi: 10.1111/nure.12076.
Trapp C.B., Barnard N.D. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr. Diab. Rep. 2010; 10(2): 152–158, doi: 10.1007/s11892-010-0093-7.
Wolever T.M., Gibbs A.L., Chiasson J.L., Connelly P.W., Josse R.G., Leiter L.A., Maheux P., Rabasa-Lhoret R., Rodger N.W., Ryan E.A. Altering source or amount of dietary carbohydrate has acute and chronic effects on postprandial glucose and triglycerides in type 2 diabetes: Canadian trial of Carbohydrates in Diabetes (CCD). Nutr. Metab. Cardiovasc. Dis. 2013; 23(3): 227–234, doi: 10.1016/j.numecd.2011.12.011.
Venn B.J., Green T.J. Glycemic index and glycemic load: measurement issues and their effect on diet-disease relationships. Eur. J. Clin. Nutr. 2007; 61(Suppl. 1): S122–131.
Blundell J.E., Stubbs R.J. High and low carbohydrate and fat intakes: limits imposed by appetite and palatability and their implications for energy balance. Eur. J. Clin. Nutr. 1999; 53(Suppl. 1): S148–165.
Astrup A., Ryan L., Grunwald G.K., Storgaard M., Saris W., Melanson E., Hill J.O. The role of dietary fat in body fatness: evidence from a preliminary meta-analysis of ad libitum low-fat dietary intervention studies. Br. J. Nutr. 2000; 83(Suppl. 1): S25–32.
Marckmann P., Raben A., Astrup A. Ad libitum intake of low-fat diets rich in either starchy foods or sucrose: Effects on blood lipids, factor VII coagulant activity, and fibrinogen. Metabolism 2000; 49(6): 731–735.
Fried S. K., Rao S.P. Sugars, hypertriglyceridemia, and cardiovascular disease. Am. J. Clin. Nutr. 2003; 78(4): 873S–880S.
Bray G.A. Potential health risks from beverages containing fructose found in sugar or high-fructose corn syrup. Diabetes Care 2013; 36(1): 11–12, doi: 10.2337/dc12-1631.
Journals System - logo
Scroll to top