- Adding intensive weight management (WM) via low-carbohydrate nutrition counseling to group medical visits (GMVs) improved clinical outcomes beyond HbA1c lowering in type 2 diabetes (T2D).
Why this matters
- GMVs typically improve HbA1c but may also lead to weight gain and hypoglycemia if accomplished via medication intensification.
- Clinical trial of 263 participants with T2D randomly assigned to 9 GMVs with counseling and medication optimization or same plus WM via low-carbohydrate diet counseling (total 13 visits).
- Analyses conducted at 48 weeks.
- Funding: US Department of Veterans Affairs.
- WM+GMV was noninferior to GMV-only for HbA1c (estimated mean difference, −0.1%; 95% CI, −0.5% to 0.2%) and not superior (P=.44).
- From baseline, HbA1c decreased:
- −0.9% (95% CI, −1.2% to −0.6%) with WM+GMV vs
- −0.8% (95% CI, −1.0% to −0.5%) with GMV-only.
- Significantly fewer hypoglycemic events in WM+GMV participants vs GMV-only (incidence rate ratio, 0.49; P<.001>
- Estimated mean number of hypoglycemic events: 3.2 (1/16 weeks) vs 6.6 (1/8 weeks).
- Meeting frequency differed in the 2 groups during first 16 weeks.
- Clinicians could not feasibly be blinded.
- Mean weight changes were modest with WM+GMV.
- Neither group met target HbA1c levels.
- Low enrollment.