**8. LCHF diets in the management of T2DM**

Any diet that reduces carbohydrate load and insulin concentrations will have a beneficial effect on diabetes. Therefore, LCHF diets are currently being discussed as a potential first-line treatment for T2DM [69, 70].

Three hundred and sixty-three patients, who were overweight and obese, were given either a ketogenic LCHF diet or a 'low calorie, high nutritional value' diet in a 6-month trial [71]. Those with T2DM (102 patients) had significantly lower HbA1c and fasting glucose levels and also lost more weight (−12.0% vs. −7.0%) with the LCHF diet.

Thirty-four prediabetic or T2DM patients were randomised to a calorie-restricted diet according to American Diabetes Association (ADA) guidelines or a very LCHF diet in another 3-month trial [72]. HbA1c did not alter in the ADA group, whereas in the very LCHF group, there was a significant reduction (6.6–6.0%) in HbA1c, decrease in the use of anti-diabetic medications and weight loss (−5.5 vs. −2.6 kg).

Westman et al. [73], in their 24-week trial comparing a very LCHF diet with a low GI diet, similarly showed greater decreases in HbA1c (−1.5% vs. −0.5%, p = 0.03) with the very LCHF diet, despite more patients reducing or stopping their diabetes medications.

In another study, 115 obese adults with T2DM were randomised to either LCHF or LFHC diet for 1 year [74]. Both diets showed significant weight loss and HbA1c reduction. LCHF diet, however, resulted in better blood glucose stability, greater reductions in diabetes medication requirements and significant improvements in all aspects of lipid concentrations.

Although it could be assumed that all the above positive metabolic changes with an LCHF diet is attributable to its associated weight loss, it is also well established that carbohydrate restriction in diabetes patients per se improves glycaemic control even in the absence of weight loss [75, 76].
