Carbohydrate-Controlled Diets and Type 2 Diabetes Management in Obese Adults

Carbohydrate-Controlled Diets and Type 2 Diabetes Management in Obese Adults

Type 2 Diabetes is one of the emerging global health concerns. The disease is characterized by persistent elevation of blood sugars. It remains a modifiable risk factor for stroke, heart disease, and hypertension. It has also been associated with escalating healthcare costs and a reduction in the quality of life of the affected persons (Dambha-Miller et al., 2023). Comprehensive management of diabetes integrates pharmacological and non-pharmacological interventions to optimize blood sugar controls and lower the prevalence of the disease by diminishing the risk of developing the disease (Quattrocchi et al., 2020). Integral to the preventative approaches to diabetes and aggressive blood sugar control among known diabetics is lifestyle modification. Lifestyle modification modalities, such as carbohydrate control, have been lauded for their effectiveness in lowering the risk of developing diabetes. There are also consensual findings on the efficacy of adjunctive use of carbohydrate control and medications in optimizing blood sugar control (Dambha-Miller et al.,2023). It is, however, unclear whether carbohydrate-controlled diets increase the remission probability of diabetes compared to conventional therapies. This paper reviews the literature on the effectiveness of carbohydrate restrictions in increasing the remission probability of diabetes. The PICOT question utilized in the review process is: In obese patients with type 2 diabetes (P), is compliance to a carb-controlled diet (I) more effective than standard medical therapy (C) at increasing the probability of remission of diabetes (O)?

Methods of Studies

The principal research methodologies delineated from the literature search were qualitative and quantitative. Qualitative researchers collect and analyze non-numerical data (Alhazmi & Kaufmann, 2022). Two qualitative research were assessed for their feasibility in answering the research question.

The first qualitative study utilized phenomenological designs to explore the perceptions and experiences of diabetics and obese individuals regarding appetite and eating behaviors (Poon et al., 2024). Phenomenological designs allow researchers to better understand a phenomenon through guided interviews (Alhazmi & Kaufmann, 2022). The investigator in this qualitative study applied semi-structured interviews to obtain information from 45 respondents. The study adequately answered the population and the intervention aspects of the research questions. It demonstrated that adult diabetic patients recognize the significance of carbohydrate control in optimizing their blood sugars.

The article by Viljoen et al. (2024) utilized qualitative methods with phenomenological designs to explore the experience of dietitians prescribing carbohydrate-controlled diets. In this case, the researchers used surveys to collect data from 47 participants. The study adequately addressed the PICOT component of the intervention. It showed that dietitians prefer prescribing carb-controlled diets. Their preference is informed by evidence demonstrating the efficacy of carbohydrate-restrictive diets in controlling blood sugars.

Quantitative methodology uses numerical data to represent research findings. These methodologies utilize surveys, among other data collection methodologies, to explain a phenomenon (Nwabuko, 2024). The quantitative studies reviewed demonstrated the efficacy of a carbohydrate-restricted diet in optimizing glycemic control.

The article by Tricò et al. (2023) utilized a quantitative methodology employing the experimental design to gather insight into the feasibility of early time-related consumption of carbohydrates in people with diabetes. Notably, experimental designs allow the researcher to test a hypothesis as well as study causal relationships between variables scientifically (Nwabuko, 2024). In this case, the researchers utilized the experimental design to establish the feasibility of early time-related consumption of carbohydrates among 27 people with diabetes. The study addressed the interventions, outcomes, and population components of the research question. It showed that carbohydrate restrictions among adult patients with diabetes optimized their blood sugar control.

The article by Unwin et al. (2023) employed quantitative methods with experimental design to evaluate the effectiveness of adjunctive use of standard therapies and a carb-controlled diet program compared to standard therapies alone in optimizing blood sugar control. The researcher utilized randomized controlled trials in which participants were placed into two groups and observed over 16 weeks. The study addressed the interventions and outcomes components of the research questions. It showed that carbohydrate control, when used together with standard therapies, produced superior glycemic control than standard therapies alone.

Results of the Studies

The first article utilized quantitative methods to determine the efficacy of early restricted consumption of carbohydrates among individuals with type 2 diabetes. The study revealed the 14-day blood glucose averages in early time-restricted carbohydrate intake produce two early postprandial glucose peaks compared to three peaks in Mediterranean diets, translating to improvements in diabetes control. This affirmed the effectiveness of early time-restricted carbohydrate intake in improving blood sugar control.

The second article utilized quantitative methodologies to compare a combined therapy integrating a web-based health education program on carbohydrate restriction and standard anti-diabetic therapy and standard therapies when used alone in optimizing blood sugar control among adults with type 2 diabetes. The study revealed weight, HbA1c levels, and medication requirements were significantly lowered in adult patients with diabetes using the web-based program on carbohydrate control alongside standard therapies compared to those using standard therapies alone. This affirmed the significance of carbohydrate-restrictive diets in improving the clinical outcomes of adult diabetics.

The third article utilized qualitative methods to explore the experiences and perceptions of adults with diabetes and obese individuals on appetite and eating behaviors. The study revealed that there is a great awareness of the significance of making healthy food choices in managing diabetes among individuals with diabetes and lowering the risk of developing the disease among at-risk populations. Basing food choices on the amount of carbohydrates allowed them to take carbohydrate-restricted diets, thereby decreasing the risk for obese individuals developing diabetes and optimizing glycemic control among patients with the disease. It is thus important for caregivers to educate their patients on the need to make healthy food choices to ensure carbohydrate restriction as a measure for enhancing disease control and minimizing the risk of developing the disease (Poon et al., 2024).

The fourth study utilized qualitative techniques to explore the experiences and perspectives of dietitians when prescribing diabetes nutrition therapy. The study revealed that dietitians recognized the significance of carbohydrate-controlled diets in optimizing glycemic control. As evident in the study, knowledge of carbohydrate-restricted diets, as informed by evidence, skewed their prescriptive practices toward carbohydrate-controlled diets. The authors further advocated for sustained education on diabetes nutrition, emphasizing lowered carbohydrate intake to improve the outcomes of patients with diabetes (Viljoen et al., 2024).

Outcome Comparison

The anticipated outcome of the highlighted PICOT questions is an increase in the probability of diabetes remission among obese adults with type 2 diabetes. The selected articles explored the effectiveness and efficacy of carbohydrate-restrictive diets in optimizing glycemic control and subsequently increasing the remission probability of the disease. There is a consensual finding from the articles on the significance of carbohydrate control in managing diabetes across the four articles. Variation, however, exists in the methodology used and the PICOT areas addressed.

The outcome of the first article was that carbohydrate-controlled diets optimized glycemic control. This outcome is consistent with the anticipated outcome but slightly differs in scope as it does not detail whether the intervention will result in disease remission. The second study also demonstrated that carb-restricted diets result in the reduction of HbA1c level, weight, and the need for anti-diabetic medication. This outcome is similar to the anticipated outcome as it proves that carbohydrate restriction could increase diabetes remission, as evidenced by the lowered need for medication and reduction in HbA1c levels and weight of the patients.

The findings from the third article are also aligned with the anticipated outcomes. The study found that persons with diabetes and those at risk of developing the disease recognize the significance of healthy food choices and carbohydrate restriction (Poon et al., 2024). The study, however, is limited in its scope and does not capture the health impact of controlling carbohydrate intake and education on carbohydrate restriction in diet remission. It instead focuses on the intervention component of the PICOT and details aspects of carbohydrate control diets such as how they are perceived by the target populations.

The fourth article utilized qualitative designs to convey dietitians experiencing prescribing carbohydrate-controlled diets (Viljoen et al., 2024). The outcomes of the study are aligned also aligned with the anticipated findings of the PICOT questions. It is, however, limited in its scope as it only focuses on the intervention component of the study. In this respect, the study emphasizes the need for carb-controlled diets but is unclear on their impact on diabetes remission or outcomes.

Proposed Evidence-Based Change

The PICOT questions are aligned with the research articles and the identified nursing problem. The identified nursing problem in the proposed research is type 2 diabetes. The disease remains a global health concern and a reason for healthcare-seeking and patient suffering. The PICOT question aligns with the highlighted nursing problem. It guides the establishment of whether carbohydrate restriction increases the probability of diabetes remission among persons with diabetes. The selected research articles also align with the PICOT question. They address several components of the PICOT question, highlighting the significance of carbohydrate control in increasing the remission potential of diabetes.

The outcomes of the reviewed articles provided insight into the role of non-pharmacological interventions in managing type 2 diabetes and lowering the risk of the disease. An evidence-based practice elucidated from research is the integration of a carbohydrate-restrictive diet in managing type 2 diabetes and lowering the risk of developing the disease.

The anticipated outcomes can be assessed through periodic evaluation of HbA1c levels. HbA1c is a prognostic marker of diabetes that aid the determination of patients’ response to anti-diabetic therapy. It is a sure way of confirming the extent of glycemic control and may reveal whether the patient has entered into remission (Kaiafa et al., 2020). Periodic evaluation of the HbA1c level will, therefore, allow the principal investigator to ascertain whether the intervention is effective.

Type 2 diabetes remains a global health concern. Comprehensive management of the disease integrates pharmacotherapy and non-pharmacological interventions. Carbohydrate control is one of the non-pharmacological interventions utilized to manage diabetes. There is a consensual research finding on the effectiveness of carbohydrate control in optimizing blood sugar control. Subsequently, carbohydrate restrictions can be applied to help obese adults to increase their probability of disease remission.

References

Alhazmi, A. A., & Kaufmann, A. (2022). Phenomenological qualitative methods applied to the analysis of cross-cultural experience in novel educational social contexts. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.785134

Dambha-Miller, H., Hounkpatin, H. O., Stuart, B., Farmer, A., & Griffin, S. (2023). Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study. PLOS ONE, 18(8). https://doi.org/10.1371/journal.pone.0290791

Kaiafa, G., Veneti, S., Polychronopoulos, G., Pilalas, D., Daios, S., Kanellos, I., Didangelos, T., Pagoni, S., & Savopoulos, C. (2020). Is hba1c an ideal biomarker of well-controlled diabetes? Postgraduate Medical Journal, 97(1148), 380–383. https://doi.org/10.1136/postgradmedj-2020-138756

Nwabuko, O. (2024). An overview of research study designs in quantitative research methodology. American Journal of Medical and Clinical Research & Reviews, 03(05), 01–06. https://doi.org/10.58372/2835-6276.1169

Poon, J. L., OHara, L., Kendal, H., Sully, K., Guy, M., Bradley, H., Tolley, C., & Mason, B. (2024). Perceptions and experiences of people with obesity and type 2 diabetes around appetite and eating behaviors: A qualitative study. Advances in Therapy, 41(5), 2028–2049. https://doi.org/10.1007/s12325-024-02846-5

Quattrocchi, E., Goldberg, T., & Marzella, N. (2020). Management of type 2 diabetes: Consensus of diabetes organizations. Drugs in Context, 9, 1–25. https://doi.org/10.7573/dic.212607

Tricò, D., Masoni, M. C., Baldi, S., Cimbalo, N., Sacchetta, L., Scozzaro, M. T., Nesti, G., Mengozzi, A., Nesti, L., Chiriacò, M., & Natali, A. (2023). Early time-restricted carbohydrate consumption vs conventional dieting in type 2 diabetes: A randomised controlled trial. Diabetologia, 67(2), 263–274. https://doi.org/10.1007/s00125-023-06045-9

Unwin, D., Delon, C., Unwin, J., Tobin, S., & Taylor, R. (2023). What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutrition Prevention & Health, 6(1), 46–55. https://doi.org/10.1136/bmjnph-2022-000544

Viljoen, A., Yu, K., Witchell, E., & Conklin, A. I. (2023). Prescribing diabetes nutrition therapy: A qualitative study of dietitians’ experiences of carbohydrate restriction in Canada. BMJ Nutrition, Prevention & Health, 6(1), 83–90. https://doi.org/10.1136/bmjnph-2022-000532

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Carbohydrate-Controlled Diets and Type 2 Diabetes Management in Obese Adults

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