Impact of a remote nutrition education on low-carbohydrate diet based in type 2 diabetes management: findings from a Brazilian primary care randomized controlled trial

Abstract

Introduction: The difficulty of nutritional management of type 2 diabetes mellitus (T2DM) in primary health care in Brazil highlight the need for innovative strategies based on nutritional education. Methods: This study evaluated the effectiveness of an online educational intervention based on a low-carbohydrate diet for adults with T2DM and compared with conventional primary care management. A 16-week parallel randomized clinical trial enrolled 58 non-insulin users (mean age: 61 years), randomized to an Intervention (n = 29) or Control group (CG) (n = 29). Results: After 16 weeks, the Intervention Group (IG) showed significant reductions in HbA1c (− 0.91 ± 0.16%), fasting glucose (− 1.46 ± 0.06 mmol/L) and BMI (− 1.63 ± 0.8 kg/m²). In contrast, the CG exhibited significant increases in fasting glucose (+ 1.03 ± 0.17 mmol/L) and Body Mass index (+ 0.96 ± 0.5 kg/m2), with no significant HbA1c change (+ 0.25 ± 0.04%). Between-group comparisons favored the IG (p < 0.001), with net differences of 1.17% in HbA1c and 27.5% in fasting glucose. Additionally, 31% of IG participants achieved HbA1c ≤ 6.5%, whereas none of the CG participants achieved the HbA1c target. Use of oral antidiabetic medication decreased significantly in the IG; notably, this reduction was not observed in the CG (44.8% vs. 0%, p < 0.001). Conclusion: In conclusion, the online education intervention improved glycemic control, reduced BMI, and lowered medication requirements, representing a promising strategy for T2DM management with potential to reduce complications and healthcare system costs.