Background - Type 2 Diabetes Mellitus (T2DM) is a growing crisis that can lead to more problems if left untreated. One of these problems includes diabetic nephropathy or Chronic Kidney Disease (CKD). While there have been many advances in the field of treating CKD with medication, there are currently no medications with the capability of stopping the progression of or reversing diabetic nephropathy; however, recent studies have shown that diabetic nephropathy can be stopped and even reversed through dietary interventions. One of these studies went through the effects of a low protein diet on diabetic nephropathy and found very promising results. This meta-analysis was designed to explore the effects of a Low Carbohydrate Diet (LCD) on diabetic nephropathy.
Methods - An electronic search of PubMed and Google Scholar was conducted. To be considered eligible the studies had to contain (‘carbohydrate’ OR ‘carbohydrates’) AND (‘diet’ OR ‘diets’) AND (‘type 2’) AND (‘diabetes’ OR ‘diabetic’) AND (‘ketogenic’). The studies also had to measure Estimated Glomerular Filtration Rate (eGFR) and Glycated Hemoglobin (HbA1c). Statistics and calculations were performed by Review Manager version 5.3 while risk of bias was assessed using the Robvis ‘risk of bias’ tool.
Findings - 262 potential articles were identified by the search and 10 studies matched the search criteria with a total of 921 participants (450 were given the LCD and 471 were given control diets). Analysis of the total Standardized Mean Difference (SMD) for the eGFR studies showed that there was no difference between the LCD and the control (total SMD: -0.00; 95% CI, -0.20 to 0.19; P = 0.97). Analysis of the serum creatinine showed similar results (SMD: 0.13; 95% CI, -0.12 to 0.38; P = 0.31). The total SMD for the HbA1c (SMD: -0.29; 95% CI, -0.55 to -0.03; P = 0.03) showed that there was a lowering of the HbA1c in the LCD and not in the control diet.
Conclusion - In this meta-analysis there was no connection found between eGFR/serum creatinine and percent carbohydrates in the diets indicating the LCD did not negatively affect the kidneys. HbA1c was found to be lower in the LCD than in the control which points to a LCD possibly leading to the reversal of T2DM which would remove the main cause of diabetic nephropathy.
Bachelor of Science (B.S.)
College of Medicine
Couch, Garrett A., "Comparison of Low Carbohydrate Diets on Renal and Glucose Function in Subjects with Type 2 Diabetes: A Systematic Review and Meta-analysis" (2020). Honors Undergraduate Theses. 691.