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Diabetes Obes Metab. 2019 Jul 26. doi: 10.1111/dom.13837. [Epub ahead of print]

An evidence-based approach to developing low-carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods.

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Faculty of Health Sciences, Discipline of Exercise and Sport Science, University of Sydney, Sydney, New South Wales, Australia.
CSIRO - Health and Biosecurity, North Ryde, New South Wales, Australia.
Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.



To identify core diet and delivery components of low-carbohydrate (CHO) diets that have demonstrated efficacy for type 2 diabetes (T2D) management.


MEDLINE, Pre-MEDLINE, EMBASE, CINAHL and the Cochrane Library of Controlled Trials databases were systematically searched from inception until August 18, 2018. Primary intervention studies of low-CHO diets (≤130 g/d or 26% total energy intake [TEI]) were included. Content analysis was performed on the low-CHO diet protocols classified as safe and effective for T2D management.


A total of 41 studies published between 1963 and 2018 were included, of which 40 were classified as safe and effective for inclusion in the primary analysis. Thirteen studies (13/40) were on very-low-CHO diets (<50 g/d), 14/40 included low-CHO diets (≤130 g/d or 26% TEI), and 13/40 were adapted according to participant progress. Thirty-one studies reported a total energy prescription, of which 18/31 encouraged ad libitum intakes. Twenty studies reported a prescribed dietary fat amount, of which 18/20 were unrestricted or high-fat (>35% TEI). Twenty-six studies reported a prescribed dietary protein amount, of which 22 were unrestricted or were high-protein (>25% TEI). The types of dietary CHO, fat and protein recommended were predominantly whole foods. Common delivery methods reported were dietician and/or physician involvement, moderate to high frequency of contact (≥1 session/month) and use of participant self-monitoring.


Multiple approaches for developing and delivering a low-CHO diet intervention for T2D management are safe and effective. A comprehensive set of core dietary components to consider in the formulation of low-CHO diet protocols were identified for use in clinical practice and to inform evidence-based guidelines for T2D management.


carbohydrate restriction; clinical practice; diet intervention; dietary guidelines; low-carbohydrate diets; systematic review; type 2 diabetes


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