Improvements in Glucose Metabolism and Insulin Sensitivity with a Low-Carbohydrate Diet in Obese Patients with Type 2 Diabetes
Abstract
OBJECTIVE: The optimal diet for weight loss in type 2 diabetes remains controversial. This study examined a low-carbohydrate, high-fat diet with detailed physiological assessments of insulin sensitivity, glycemic control, and risk factors for cardiovascular disease. METHODS: Fourteen obese patients (body mass index [BMI] 40.6 ± 4.9 kg/m(2)) with type 2 diabetes were recruited for an "Atkins"-type low-carbohydrate diet. Measurements were made at 0, 12, and 24 weeks of weight, insulin sensitivity, HbA1c, lipids, and blood pressure. RESULTS: Twelve completers lost a mean of 9.7 ± 1.8 kg over 24 weeks attributable to a major reduction in carbohydrates and resultant reduction in total energy intake. Glycemic control significantly improved (HbA1c -1.1 ± 0.25%) with reductions in hypoglycemic medication. Fasting glucose, homeostasis model assessment (HOMA), and area under the curve (AUC) glucose (intravenous glucose tolerance test [IVGTT]) were significantly reduced by week 12 ( p < 0.05). There were nonsignificant improvements in insulin sensitivity (SI) at week 12 ( p = 0.19) and week 24 ( p = 0.31). Systolic blood pressure was reduced (mean -10.0 mmHg between weeks 0 and 24, p = 0.13). Mean high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol all increased. The ratio of total: HDL cholesterol and triglycerides was reduced. CONCLUSION: A low-carbohydrate diet was well tolerated and achieved weight loss over 24 weeks in subjects with diabetes. Glycemic control improved with a reduction in requirements for hypoglycemic agents.
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The effects of ketogenic diet on lipid parameters remain contentious, with some studies reporting positive improvements and others observing increases in lipid profiles.
“However, its effects on lipid parameters remain contentious. Some studies report positive improvements, while others observe increases in lipid profiles [8, 9].”
From Ketogenic diet-induced changes in adult lipid metabolism: a comprehensive systematic review and meta-regression of randomized controlled trials (2026) · cites this paper as [9]
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“Some studies report positive improvements, while others observe increases in lipid profiles [8, 9].”
- Authors
- Krebs, J. D., Bell, D., Hall, R., Parry-Strong, A., Docherty, P. D., Clarke, K., & Chase, J. G.
- Affiliations
- Wellington Hospital (NZ)
- University of Canterbury (NZ)
- Venue
- Journal of the American College of Nutrition
- Publisher
- Informa UK Limited
- Published
- 2013-02
- Volume
- 32
- Issue
- 1
- Pages
- 11-17
- ISSN
- 0731-5724 (ISSN-L)
- 1541-1087
- OpenAlex
- W2069149757
- Cited by
- 65
- References
- 42
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 2 · 2020: 10 · 2019: 6 · 2018: 8 · 2017: 4 · 2016: 4 · 2015: 7 · 2014: 2 · 2013: 1
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- UC Research Repository (University of Canterbury) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- low-carbohydrate diet, type 2 diabetes, obesity, insulin sensitivity, glucose metabolism, glycemic control, weight loss, Atkins diet, HbA1c, lipid profile, blood pressure, cardiovascular risk factors
- MeSH terms
- Blood Glucose, Blood Pressure, Energy Intake, Cardiovascular Diseases, Cholesterol, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Dietary Fats, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin Resistance, Cholesterol, HDL, Cholesterol, LDL, Male, Obesity, Risk Factors, Weight Loss, Body Mass Index, Area Under Curve, Diet, Carbohydrate-Restricted, Diet, High-Fat
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