Posted Apr 19 , 2019 09:10 AM

Outcomes of a Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program: 1-Year Results of a Single-Arm Longitudinal Study.

Saslow LR, et al. JMIR-Diabetes 2018;3:e12

Institute Summary (excerpted from the Abstract):

Typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. The objective of this study was to evaluate the 1-year outcomes of the digitally delivered Low-Carb Program, a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring. The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. The authors randomly selected participants to be followed for 1 year (N=1000; mean age 56.1yrs, 59% women; mean HbA1c 7.8%, mean body weight 89.6 kg; taking mean of 1.2 diabetes medications. Of the 1000 study participants, (70.8%) individuals reported outcomes at 12 months, 67.2% completed at least 40% of the lessons, and 52.8% completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% reduced one or more of these medications. Almost half (46.4%, of all participants lost at least 5% of their body weight). Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% and lost an average of 6.9% of their body weight.

Why is this important?

The Low-Carb Program is a completely automated, structured 10-week health intervention for adults with type 2 diabetes and includes digital tools for submitting self-monitoring data on a number of different variables including blood glucose levels, blood pressure, mood, sleep, food intake, and body weight. Weekly automated feedback is provided to users based on their use of the program through email notification. The modules are designed to help participants gradually reduce their total carbohydrate intake to less than 130 grams per day to meet their self-selected goals While the carbohydrate intake of less than 130 grams/day is not so low as to be a ketogenic diet (Feinman RD, et al. Nutrition 2016;31:1–13) it is still lower than the average diet in the US. The use of low-CHO diets in diabetes can be traced back to 1797 when Dr. John Rollo was said to have “cured” an army officer named Captain Meredith of his diabetes by directing “ entire abstinence of every kind of vegetable matter in the diet”, which by default became a diet of nearly all meat. While this approach is considered radical by some, it is the basis of many approaches to ketogenic diets a well as reduced carbohydrate diets for weight loss. I cannot find that this program is generally available, but it is based on a published system (Unwin D, et al. Diabesity in Practice 2015;4:102-108). Weight loss and weight loss maintenance are among the ‘holy grails’ of diabetes treatment and this may be a promising avenue of patient engagement. If an online program with proven results in weight loss and weight loss maintenance were available, how would that affect your practice?

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