Systematic review and meta-analysis of low carb diets in BMJ

The BMJ has recently published this:-

Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data
https://www.bmj.com/content/372/bmj.m4743
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Importantly, the authors have excluded studies where diets where the diet was described as 'low carbohydrate' but contained more than 130 g carbohydrate per day. (Some previous reviews included studies which would more appropriately be described as 'moderate carbohydrate' which may have muddied the results.)

The conclusion was:- 'On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences.'

 

Yes, a lower chance than those not using insulin. The discussion in the paper says:-

Subgroup analyses, based on credibility testing, suggested that patients not using insulin, compared with those that did, had increased diabetes remission rates at six months. For patients not using insulin, the NNT was 2 for remission defined as HbA1c below 6.5% and 5 for remission defined as HbA1c below 6.5 without diabetes medication. ​

 

As far as I know, the study didn't look into the reasons for that. It might because insulin use equates with worse hyperglycaemia and so greater chance of irreversible damage to the beta cells. Or it might be because GPs are get insulin users to aim for a higher HbA1c in order to avoid hypos.