Data availability statement: All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available on reasonable request. The optimal diet to improve glycemia in patients with type 2 diabetes remains unclear. Low carbohydrate, high fat LCHF diets can improve glycemic control, but have not been investigated in real-world settings. The primary outcome was change in A1C from baseline to the end of follow-up. In a community-based cohort of type 2 diabetes, the LCHF diet was associated with superior A1C reduction, greater weight loss and significantly more patients discontinuing or reducing antihyperglycemic therapies suggesting that the LCHF diet may be a metabolically favorable option in the dietary management of type 2 diabetes. Prior studies indicate that low carbohydrate, high fat LCHF diets have the potential to improve glycemic control and result in reduction of glucose lowering medications. To our knowledge, this is the first study to date that investigates the implementation of the low carbohydrate, high fat LCHF diet in a community-based setting, making the results generalizable and applicable to the clinical practitioner. All patients following the LCHF diet who initially took insulin had either a reduction or discontinuation of this therapy by their healthcare provider when clinically indicated, compared with less than a quarter of those receiving usual care. For motivated patients, the LCHF diet should be considered as a viable treatment option for type 2 diabetes. What patient characteristics are predictive of greater levels of glycemic reduction utilizing the LCHF diet?
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