Low-carbohydrate diet: a promising strategy for type 2 diabetes management among Egyptian patients

Abstract Background Type 2 diabetes mellitus (T2DM) is a growing public health burden worldwide, with Egypt among the countries most affected. Low-carbohydrate diets (LCDs) have shown promise in improving glycemic control, yet limited data compare their effect directly with medication intensification. This study aimed to assess the effectiveness of an LCD (< 130 g/day) on glycemic control and metabolic parameters in Egyptian patients with T2DM over 12 weeks. Methods This non-randomized controlled clinical trial enrolled 90 patients aged 35–64 years with T2DM (HbA1c 7–8%), BMI 25– < 35 kg/m 2 , on oral antidiabetic medications. Participants were allocated to either an LCD group ( n = 45) receiving structured dietary counseling or an intensified oral hypoglycemic medication (IOH) group ( n = 45). Primary outcome was the change in HbA1c; secondary outcomes included lipid profile, body weight, waist circumference (WC), body mass index (BMI), blood pressure, and anti-glycemic medication requirement, assessed at baseline and after 3 months. Results After 3 months, HbA1c levels improved significantly in both groups (LCD: –5.6% [95% CI: 5.05–7.89]; IOH: –6.7% [95% CI: 6.78–8.17]), with no statistically significant between-group difference ( p = 0.056). The LCD group demonstrated clinically meaningful reductions in weight (–2.5% [95% CI: 2.54–4.54]), waist circumference (–1.9% [95% CI: 1.46–2.91]), and BMI (–2.8% [95% CI: 2.72–5.27]) ( p < 0.001 for all). Diastolic blood pressure decreased significantly (–4.68% [95% CI: 1.30–8.05], p < 0.001), with no significant change in systolic blood pressure (percent change 1.88% [95% CI: –0.46 to 4.22], p = 0.174). Lipid profiles improved notably in the LCD group, with reductions in triglycerides (–5.1% [95% CI: 0.11–10.6], p = 0.016), LDL cholesterol (–5.0% [95% CI: –1.17 to 11.09], p < 0.001), and total cholesterol (–4.5% [95% CI: 2.43–6.50], p < 0.001), alongside an increase in HDL cholesterol (+ 5.0% [95% CI: –3.64 to –0.67], p = 0.015). Additionally, the LCD group experienced a significant reduction in antidiabetic medication requirements, reflected by a decrease in medication effect score (MES) from 1.0 to 0.88 ( p = 0.003). Conclusions A 3-month LCD intervention produced significant and clinically meaningful improvements in glycemic control, lipid profile, weight, waist circumference, BMI, and diastolic blood pressure among Egyptian patients with T2DM, while also reducing reliance on medications. LCD represents a safe, effective, and accessible dietary strategy for T2DM management, offering comparable benefits to pharmacological intensification but without the associated medication burden. Future research should explore the long-term sustainability and cardiovascular outcomes of LCD interventions.