New study: low-carb education in a group setting for the win

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Carbohydrate restriction for diabetes has received a lot of attention over the past year, including the landmark American Diabetes Association consensus report endorsing it as the most effective option for blood sugar management.

We also saw impressive two-year study results from Virta Health showing that people with type 2 diabetes who received low-carb education and support achieved greater improvements in blood sugar control, weight loss, and heart disease risk factors than those who received standard diabetes care. These results confirmed that a carb-restricted approach is beneficial and sustainable long term.

Some may wonder whether the success of the low-carb participants was due in part to the continuous nutrition and medical support they received from the Virta Health team, compared to the limited interaction the standard care group had with their own diabetes team.

However, a new randomized controlled trial (RCT) has shown that a low-carb intervention with frequent group support has the edge over conventional diabetes treatment with similar group support:

JAMA Internal Medicine: Comparison of group medical visits combined with intensive weight management vs group medical visits alone for glycemia in patients with type 2 diabetes

In this 48-week study, patients with type 2 diabetes were randomly assigned to group education focused on improving blood sugar with intensive dietary therapy (carb restriction) or intensive medication therapy (insulin and/or oral diabetes medications), along with routine diabetes care. The study participants were US veterans who were overweight and had poor blood sugar control.

All patients attended small group education classes taught by a registered dietitian or registered nurse every 2 to 4 weeks for the first 16 weeks. After each session, patients met with a physician for medication management. For the remainder of the study, classes and medical appointments were held once every 8 weeks.

Participants in the low-carb group were advised to limit carbs to less than 30 grams per day and to eat as much as needed to feel full rather than deliberately restricting calories. In their group meetings, they received advice about grocery shopping, low-carb recipe makeovers, dining out, and other practical guidance.

Those in the standard care group were provided with conventional diabetes education classes, including self-management techniques and preventing complications.

After 16 weeks, the low-carb group’s HbA1c had decreased by an average of 1.7%, compared to 1.0% in the other group. Yet by the end of the trial, when classes and meetings were much less frequent, the HbA1c for both groups had crept up, although still averaging about 0.8% lower than their starting values.

One of the reasons for the modest HbA1c results in the low-carb group is likely that carb intake often averaged 90-110 grams per day — more than three times the 30-gram limit they were advised to follow. This was still a great improvement on their pre-trial diet, though.

Additionally, the low-carb group achieved other benefits by the study’s end, including:

  • Significant reduction in diabetes medication, compared to an increase in the conventional treatment group
  • An average loss of 9 pounds (4.1 kg) vs. less than 1 pound in the conventional treatment group
  • 50% fewer episodes of hypoglycemia than the conventional treatment group

Eating low carb nearly always reduces the need for diabetes medication, which in turn decreases the risk of low blood sugar. This is among the most appreciated effects of carb restriction. As the researchers stated, “Hypoglycemia is commonly identified by people with diabetes as a cause for apprehension and is correlated with lower quality of life. In addition, fear of hypoglycemia can interfere with efforts at more intensive glycemic control.”

In a press release from Duke Medical Center, lead author Dr William Yancy summed up the study’s findings: “Intensive weight management using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification. We know that lifestyle changes can be difficult to maintain, but this study shows that group meetings can be an efficient and effective strategy that helps patients sustain these improvements.”

As a registered dietitian and certified diabetes educator who previously taught group classes to veterans with diabetes, I’m very happy with the results of this study. I’m also encouraged by Virta Health’s recent partnership with the Veterans Administration. My hope is that low-carb diabetes education in a group setting will soon be offered on a much larger scale, leading to better health and quality of life for thousands of men and women who have served their country.

This study showed the group support is key to achieving the best results. If you’d like to get the benefits of low-carb group support, consider becoming a member, which includes our Facebook group and other opportunities to interact with our community.


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