Background: Five percent of the population in the Netherlands suffers from weight related diabetes mellitus type 2. Low carb diets are increasingly successful in T2 diabetes management, although it remains unclear what the carbohydrate content should be. Design: A three-arm study from dietitian practices nationwide to compare a 6x6 diet (VLCKD with 36 g/ carbs; 1.2 g protein/kg bw), a moderate low carb diet (LC, 100 g/carbs), or an energy restricted diabetes diet (ER, no carb restriction) on HBA1C; and medication in adults with overweight/obesity and T2DM at 3, 6 and 12 months. Results: Data of 356 (n=115; 126; 115) patients from 16 practices were analysed. Patients on 6x6 lost more weight both at a 3; 6 and 12 months than on LC (p<0.01; 0.02 ; after 12 months p=0.08), or ER (p<0.01 at 3, 6 and 12 months). In 37% of patients on 6x6 HBA1C levels reduced to <6.1% (<43 mmol/mol) after 12- months. Mean HbA1C declined on the 6x6 diet significantly compared to ER diet (p=0.004). In patients on 6x6 diet SU-derivatives and insulin decreased significantly more at 3-, 6- and 12- month follow-up (p<0.01); metformin decreased only between 6x6 diet and LC after 12 months (p<0.001). Conclusions: The 6x6 diet® was more effective for patients with weight related T2DM than LC or ER diet, for weight loss, remission of T2DM, HbA1C-levels and reduction of diabetes medication. A very low carbohydrate diet improves diabetes outcomes significantly better than a more moderate carbohydrate restriction or energy restricted diet.
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