As GPs we constantly seek evidence-based interventions to better manage and prevent the progression of chronic conditions like type 2 diabetes (T2D). One such intervention that continues to gain traction is therapeutic carbohydrate reduction (TCR). A review published in MDPI has further strengthened the case for this approach, showing substantial benefits in glycemic control and weight loss for patients with T2D.

Key findings from the MDPI review

The review published in MDPI analysed several studies examining the effects of low carbohydrate diets on individuals with T2D. The results were compelling:

1. Improved glycemic control: The study found that low carbohydrate interventions significantly reduced HbA1c in individuals with T2D and in some cases patients can achieve diabetes remission. This was consistent across different carbohydrate reduction levels, from moderate to very low carb diets.
2. Weight loss benefits: Besides improved glycemic control, patients following low carb diets experienced notable weight loss and improve lipid profiles in individuals with obesity. The reduction in carbohydrate intake leads to decreased insulin levels, promoting fat breakdown.
3. Sustainability: Many of the studies reviewed showed that patients on low carb diets could maintain these improvements over extended periods, providing further evidence that this approach is effective and sustainable in the long term.
4. Cardiovascular Health: Adopting a low carb diet may improve markers of cardiovascular health, such as lowering triglyceride levels and increasing HDL cholesterol. However, the long-term effects on cardiovascular outcomes require further research.

These findings align with broader research supporting low carbohydrate diets as an effective management tool for T2D. The growing body of evidence makes it clear: reducing carbohydrate intake can play a significant role in managing blood sugar, improving weight outcomes and potentially reversing T2D in some cases.

The case for Therapeutic Carbohydrate Reduction in clinical practice

While diet recommendations for managing T2D have traditionally focused on moderate calorie restriction and balanced macronutrient intake, there is a strong push for more sustainable dietary strategies like carbohydrate reduction. But how can GPs integrate this into their practice in a practical, safe and evidence-based way? Dr David Unwin, a low carb GP from the UK, and co-author of the MDPI review, shares his advice for implementing TCR in your practice. 

A blueprint for implementing TCR in your clinic

1. Assess patient suitability: Not all patients are candidates for a low carbohydrate approach. Start by assessing their health, medical history and willingness to make dietary changes. For patients who are overweight, have metabolic syndrome, or struggle with blood sugar control, TCR can be an especially effective strategy.
2. Provide education and resources: Patients may be unfamiliar with carbohydrate reduction and how to implement it. Providing educational materials—simple guides on which foods to focus on (proteins, healthy saturated fats and low carb vegetables) and which to avoid (processed grains, sugary foods, starchy vegetables)—can empower patients to take action.
3. Set realistic goals: Start with a modest carbohydrate reduction and set achievable goals. For example, the aim is to initially reduce daily carbohydrate intake by 20–30% and increase the intensity over time. It’s crucial to individualise the approach based on the patient’s preferences, comorbidities and progress.
4. Monitor progress and adjust: Regular blood glucose, weight and overall well-being monitoring is essential. For patients on TCR, check HbA1c and fasting glucose levels every 3–6 months. In the early stages, more frequent visits (every 4–6 weeks) can help identify and address patients' challenges while adapting to the new diet.
5. Collaboration with dietitians: Partner with a dietitian who has experience with low carb nutrition. They can help patients navigate the practical aspects of the diet and offer tailored advice to ensure they’re getting all the necessary nutrients.
6. Support for long-term maintenance: TCR can be challenging for patients to sustain long-term, so support is critical. Encourage regular follow-ups to discuss difficulties, celebrate successes and reinforce the benefits of carbohydrate reduction for managing T2D. Group support settings or online communities such as the Defeat Diabetes Members Community may also provide additional motivational benefits.
7. Evaluate results and adjust medications: Establish baseline data: Weight, waist, height, TBC, HbA1c, renal, and fasting lipids and review every 2-4 weeks. As patients progress on their low carb journey, some may require reductions in their medications, particularly if they achieve significant weight loss or improve glycemic control:  
   • Insulin, gliclazide: Reduce dose/stop but monitor closely.
   • SGL2 Inhibitors: Stop, but monitor blood glucose.
   • Hypotension: Explain that with weight loss, BP may well improve, and medications for this may be reduced
   • Be prepared to adjust medications accordingly to prevent hypoglycaemia or other adverse effects. Always monitor renal function and other parameters when making adjustments to medications.

To learn more about implementing low carb in your clinic, join the Defeat Diabetes RACGP-approved CPD ‘Evidence-based strategies for TCR in type 2 diabetes’. In this CPD activity, you’ll learn the science and practical strategies for managing patients transitioning to a TCR approach from a team of low carb health professionals, including Dr Paul Mason and Dr Peter Brukner OAM.

Conclusion

The latest evidence supports low carbohydrate diets' role in managing type 2 diabetes. As GPs, we have an opportunity to incorporate this strategy into our clinical practice to help patients achieve better blood glucose control, weight loss, and ultimately improve their quality of life.