Is Low-Carbohydrate Diet Safe and Effective for Type 2 Diabetes Remission in Long-Term?

Type 2 Diabetes Mellitus (T2DM) is severe global public health crisis, with the number of affected individuals rising dramatically from 200 million in 1990 to 830 million in 2022. If left unmanaged, T2DM can lead to serious complications, including kidney failure, retinopathy, neuropathy, and cardiovascular disease.

Although pharmacological treatments are available, achieving sustained glycemic control and long-term remission in type 2 diabetes mellitus (T2DM) remains challenging. Dietary approaches, particularly low-carbohydrate diets (LCDs) and ketogenic diets (KDs), are increasingly being explored for their potential to improve metabolic health and promote T2DM remission (achieving HbA1c of <6.5% without taking glucose lowering medication). The current systematic review assessed the long-term effectiveness and safety of LCDs and KDs in the management and possible remission of T2DM.

Researchers searched PubMed and the Cochrane Library for open-access studies between 2000 and 2024, involving adults (≥18 years) with type 2 diabetes who followed a low-carbohydrate diet (50–130 g/day) or ketogenic diet (≤50 g/day) for at least 12 months. Of 124 studies identified, six met all inclusion criteria. Follow-up ranged from one to eight years and included both randomized and non-randomized trials. Primary outcomes assessed were T2DM remission, HbA1c, body weight, and BMI; secondary outcomes included blood pressure, lipid profiles, and adverse events.

Key findings from the study include:

1. Consistent improvements in metabolic health among participants following LCDs or KDs. HbA1c levels decreased significantly, accompanied by notable reductions in body weight and BMI. Several studies also reported improvements in systolic blood pressure and overall lipid profiles, including lower triglycerides and LDL cholesterol, and increased HDL cholesterol.
2. Remission rates peaked at one year at up to 62%, declining to 13% by year five, with sustained remission strongly associated with weight loss of 10kgs or more. The interventions also led to a substantial reduction in medication use.
3. Positive safety profiles, with no significant adverse events or fatalities reported during follow-up, despite widespread medication discontinuation.

This systematic review showed long-term evidence that low-carbohydrate and ketogenic diets are effective and sustainable for long-term remission in T2DM. They improved glycemic control, body weight, and cardiometabolic health, offering a noninvasive alternative to pharmacological treatment. However, long-term adherence remains a challenge. Future research should refine dietary guidelines, identify ideal patient groups, and assess quality-of-life and safety impacts to integrate such interventions into standard diabetes care.

Reference: Das R, Mohammad N, Islam M, et al. (September 27, 2025) Long-Term Efficacy and Safety of a Low-Carbohydrate Diet in Type 2 Diabetes Remission: A Systematic Review. Cureus 17(9): e93340. doi:10.7759/cureus.93340