The effect of Non-Caloric Restricted, Low-Carbohydrate Diet in Reversing Type 2 Diabetes Mellitus among Active Omani Diabetic Patients Attending North Mawaleh Health Center - Abstract
Background: There is growing evidence that low-carbohydrate diet can positively improve glycemic index in patient with type 2 diabetes mellitus in compare with currently recommended method of low fat, high carbohydrate diet for the same group. However, more researches are needed to prove the effectiveness and safety of this type of diet before starting to implement it to diabetic patients. Objective: This study focused on the effectiveness of non-caloric restricted, low-carbohydrate diet in improving glycemic control over 24-week period in active Omani diabetic patients attending primary care setting at North Mawaleh health center in Muscat Government. Research design and method: This is prospective descriptive study with longitudinal follow up and pre-test, post- test comparison. Eighty-three patients were recruited. Blood collected at baseline, at 12-week and 24-week. Each patient was advised to follow non-caloric restricted low-carbohydrate regimen (< 80 gm of carbohydrate per day) and exercise recommendations. The patients were seen every alternate week in the first month then monthly to look for reflow measurements, counselling and medication adjustment. The primary outcome was glycated hemoglobin (HbA1c). Result: Seventy-one patients were able to complete the study. Non-restrictive low-carbohydrate diet (< 80 gm of carbohydrate/day) showed marked reduction in glycated hemoglobin in 24-week period by 11.58%, from 7.12 (SD1.067) % at week 0 to 6.28(SD1.066) % at week 24, p value < 0.05. This reduction was noticed along with adjustment of diabetic medications. Additionally, the percentage of patients with optimal level of HbA1c (<7%) was improved from 58 % of total patients studied to 79 % by the end of the study. There was significant mean weight reduction by 7.33 % from 82.63(SD14.3) kg to 76.67(SD14.90) kg (p value <0.05). High density lipoprotein increased from 1.30(SD0.297) to 1.40(SD0.468) mmol/l, p value <0.05 and TAG was reduced from 1.47(0.934) to 1.22(0.564) mmol/l value <0.05. The mean eGFR was declined from 86.73 (SD6.21) to 84.92 (SD8.47) ml/minper1.73m2 at the end of the study (p value <0.05). Diabetic medications were stopped in 18 (25.4%) patients, reduced in 7(9.8%) patients, increased in patients 2(2.8%), and unchanged in 44(62.0%) patients. The linear regression failed to show any correlation between reduction in HbA1c and weight changes. Conclusion: Non-caloric restricted LCD improved glycemic control in patient with type 2 DM. It also improved lipid profile, BMI and medication requirements. However, it demonstrated adverse effect on eGFR in patient with normal eGFR. Further controlled studies are warranted.