Obesity Abstracts

Background: Clinical trials have shown promising evidence that low-carbohydrate diets can improve glycaemic control in people with diabetes but the interventions have been intensive and delivered in specialist settings or with specialist staff. Given that most people with diabetes are cared for in primary care, we examined the feasibility and initial effectiveness of a behavioural support programme for low-carbohydrate diets delivered by practice nurses for people with type 2 diabetes.

Methods: Patients with type 2 diabetes and BMI≥30 kg/m² were randomised 2:1 intervention or control (usual care) and followed up at 12 weeks. The intervention diet comprised eight weeks of a food-based diet estimated to provide 800 kcal/day, excluding all foods that contain significant amounts of carbohydrate, thereafter progressing to a low-carbohydrate diet intended to meet energy needs for weight maintenance, for a further four weeks. Practice nurses delivered the programme in four 10–20 minute appointments, providing support and motivation, including advice on goal-setting and self-monitoring, and a self-help booklet with sample menus. Focus groups with participants and healthcare professionals explored intervention experience and acceptability.

Results: 33 patients (55% female, 94% of white British ethnicity) were randomised, with a mean age of 67 years (SD 11 years), and baseline BMI 35.4 kg/m² (SD 4.7 kg/m²). All patients agreed to attempt their allocated dietary interventions after randomisation, and all but one control group participant who died attended follow-up at 12 weeks. Mean (±SD) weight loss in the intervention group was 9.5 kg (±5.4 kg), compared to 2 kg (±2.5 kg) in the control group (adjusted between-group difference −7.5 kg (−11.0 to −4.0), P<0.001)). Mean (±SD) reduction in HbA1c in the intervention group was 16.3 mmol/mol (±13.3 mmol/mol), compared to 0.7 mmol/mol (±4.5 mmol/mol) in the control group (adjusted between-group difference −15.7 mmol/mol (−24.1 to −7.3, P 0.001)).

Conclusions: It is feasible to recruit participants to a low-carbohydrate intervention, for practice nurses to deliver and support the programme in primary care, and to retain participants in both groups within a trial over 12 weeks. There is evidence of clinically significant improvements in weight and glycaemic control in the short term. This suggests a full trial is both feasible and worthwhile.

Keywords: Diabetes, weight loss

Disclosures: CB authored ‘The 8-week blood sugar diet recipe book’, published 2016. PAD is a member of the PHE/SACNE/DUK committee reviewing evidence on effects of low-carbohydrate diets in diabetes.