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Published: 27 August 2023
A web-based low carbohydrate diet intervention significantly improves glycaemic control in adults with type 2 diabetes: results of the T2Diet Study randomised controlled trial

Jedha Dening, Mohammadreza Mohebbi, …Sheikh Mohammed Shariful Islam …
Nutrition & Diabetes volume 13, Article number: 12 (2023)


Abstract
Background/objectives
In people with type 2 diabetes mellitus (T2DM), low carbohydrate diets (LCD), defined as 10–<26% total energy intake from carbohydrate, have indicated improved glycaemic control and clinical outcomes. Web-based interventions can help overcome significant challenges of accessibility and availability of dietary education and support for T2DM. No previous study had evaluated a web-based LCD intervention using a randomised controlled trial (RCT) design. The objective of this study was to assess whether a web-based LCD programme provided in conjunction with standard care improves glycaemic control in adults with T2DM.

Subjects/methods
A 16-week parallel RCT was conducted remotely during Covid-19 among the general community, recruiting adults with T2DM not on insulin aged 40–89 years. Participants were randomly assigned (1:1) to standard care plus the web-based T2Diet healthy LCD education programme (intervention) or standard care only (control). The primary outcome was haemoglobin A1c (HbA1c). Secondary outcomes were weight, body mass index (BMI), anti-glycaemic medication, dietary intake, and self-efficacy. Blinded data analysis was conducted by intention-to-treat.

Results
Ninety-eight participants were enrolled, assigning 49 to each group, with 87 participants (n = 40 intervention; n = 47 control) included in outcome analysis. At 16 weeks, there was a statistically significant between-group difference favouring the intervention group, with reductions in HbA1c –0.65% (95% CI: –0.99 to –0.30; p < 0.0001), weight –3.26 kg (p < 0.0001), BMI –1.11 kg/m2 (p < 0.0001), and anti-glycaemic medication requirements –0.40 (p < 0.0001), with large effect sizes Cohen’s d > 0.8.

Conclusion
This study demonstrated that as an adjunct to standard care, the web-based T2Diet programme significantly improved glycaemic control and clinical outcomes in adults with T2DM. In addition, the results highlight the potential to improve access and availability for people with T2DM to achieve glycaemic control and improved health through web-based dietary education and support.

Glycemic control is crucial for T2DM patients, as it supports achieving and maintaining glycemic targets and optimizing health outcomes. Carbohydrate reduction and counting are essential for improved self-management in T2DM patients.
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Overall, the study findings showed that the T2Diet program significantly improved clinical outcomes and glycemic control among adult T2DM patients as an adjunct to conventional therapy, consistent with previous meta-analyses of in-person LCD dietary interventions for T2DM.

Furthermore, the findings emphasized the potential for online nutritional support and education to increase availability and access for T2DM patients to achieve glycemic control and improve health.