One of the hallmarks of type 2 diabetes is high glycated hemoglobin (HbA1c) – it shows the three-month average blood glucose concentration. When a person is diagnosed with type 2 diabetes they will be told to control their disease with several life-style changes: change diet and exercise regularly. If all else fails, they will be prescribed different antidiabetic medications. The doctor will know that diabetes is well controlled if there are decreases in HbA1c.
There are many studies trying to find the best life-style factors modifications to help the growing number of type 2 diabetes sufferers. The JMIR Diabetes journal recently published a paper on a very interesting study that used intensive nutrition and behavioral counseling, using the internet. 262 individuals were recruited to participate in an outpatient intervention. The average age was 54 years, the average BMI 41 and all of the participants had type 2 diabetes.
One of the many baseline measurements that the researches did was glycated hemoglobin. The average HbA1c at baseline was 7.6% with only 52% of the participants having the HbA1c below 6.5% – the healthy range.
For ten weeks, the participants were included in a program focusing on reducing carbohydrate intake with moderate protein intake and increased fat intake. Each individual had an individually prepared program, but typically the intake of carbohydrates was restricted to 30 grams per day. The goal was to achieve a dietary ketosis in the participants. On top of the dietary plan, they were provided with training and individual counseling: each participant selected the method – either in person at the clinic or via a mobile application. The scope and content of these training and consultations were the same in both cases and included education in the field of low carbohydrate nutrition, disease, managing the challenges of the disease and advice how to deal with the stress). The participants also received devices that daily reported their glucose and ketone body concentration of beta-hydroxybutyrate and, of course, the current body weight. After ten weeks, the values of glycated hemoglobin and other diabetic parameters were re-measured.
Glycated hemoglobin HbA1c decreased by 1% on average; 56.1% of participants achieved a HbA1c level of 6.5% after ten weeks! Nearly 60% of participants either reduced the dose or completely discontinued treatment with one or more medicines. Additionally, they lost 7.2% of weight – on average. The mean concentration of beta-hydroxybutyrate in the participants was 0.6 mmol / l in ten weeks, indicating that the participants were consistent with low carb intake and that they were constantly in a mild ketosis. Decreased HbA1c levels were comparable regardless of how the patient received counseling and support (through the application or at the clinic) (McKenzie et al., 2017).
MCKENZIE, A.L. et al. 2017. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes, vol. 2, no. 1, pp. e5, 10.2196/diabetes.6981
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