The effect of a low carbohydrate energy-unrestricted diet on weight loss in obese type 2 diabetes patients - A randomized controlled trial

Background & aims: Trials assessing the effectiveness and safety of the Atkins diet for weight loss in obese diabetic patients are limited and adherence is problematic. The current trial compared an Atkins-like diet to a conventional ADA-recommended diet over a one year period. Methods: 52 type 2 diabetes patients, aged 35-75, BMI 30-39.9 kg/m ², HbA1c > 7%, treated by diet or oral medication, were initially placed on a DASH diet for one month, then randomly assigned to a modified Atkins diet (ATK) with unrestricted calorie intake or a standard American Diabetes Association (ADA) calorie-restricted diet. Weight, fasting blood glucose, lipid profile, blood pressure, and microalbuminuria were measured at baseline and after 1.5, 3, 6 and 12 months, and compliance with the diets was assessed. Results: Similar weight loss and decrease in HbA1c were observed in both groups. Improvement in glycemic control and cardiovascular risk factor levels accompanied the modest weight reduction, with no significant between-group differences. ATK was not associated with untoward renal effects. Substantial drop-out in both groups was noted. Conclusion: There was no statistically significant advantage in terms of weight loss or glucose control for the Atkins-like diet. Adherence to a very low carbohydrate diet in a population accustomed to a Mediterranean-type diet rich in fruits and vegetables was modest, thus restricting its applicability to selected obese diabetes patients.