Impacto de um programa remoto de dieta com baixo teor de carboidratos no manejo do diabetes tipo 2: achados de um ensaio clínico randomizado na atenção primária brasileira

Abstract

The difficulty of nutritional management and the high prevalence of type 2 diabetes mellitus (T2DM) in primary health care in Brazil highlight the need for innovative strategies based on nutritional education. This study evaluated the effectiveness of an online educational intervention based on a low-carbohydrate diet for adults with T2DM, compared with conventional primary care management. This 16-week parallel randomized clinical trial included 58 non-insulin users (mean age 61 ± 11.3 years; baseline HbA1c 8.3 ± 1.3%) allocated to an Intervention Group (IG, n = 29) or Control Group (CG, n = 29). After 16 weeks, the IG showed significant reductions in HbA1c (−0.91 ± 0.16%; p < 0.001), fasting glucose (−26.2 ± 1.1 mg/dL; p = 0.0004), body weight (−4.35 ± 1.6 kg; p < 0.001), and BMI (−1.63 ± 0.8 kg/m²; p < 0.001). In contrast, the CG exhibited increases in fasting glucose (+18.6 ± 3.1 mg/dL; p = 0.019), body weight (+2.53 ± 1.3 kg; p = 0.0002), and BMI (+0.96 ± 0.5 kg/m²; p = 0.0002), with no significant HbA1c change (+0.25 ± 0.04%; p = 0.304). 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 intervention group; notably, this reduction was not observed in the control group (44.8% vs. 0%, p < 0.001). In conclusion, the online nutritional education intervention based on a low-carbohydrate diet effectively improved glycemic control, reduced body weight, and lowered medication requirements. Remote monitoring represents a scalable and promising approach for managing T2DM, enhancing adherence, expanding access to care, and reducing disease complications and healthcare system costs.