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A clinician's guide to inpatient low carbohydrate diets for remission of type 2 diabetes : toward a standard of care protocol

Mark Cucuzzella*, Adele Hite, Kaitlyn Patterson, Laura Saslow & Rory Heath

Type 2 diabetes (T2DM) is most often treated as a chronic progressive condition. However, both clinical experience and scientific studies have shown that remission indicated by a normalizing of blood glucose levels and safe medication reduction through lifestyle change should be considered an achievable clinical outcome for patients with T2DM. Dietary interventions that include therapeutic levels of carbohydrate reduction can be used by clinicians to help patients reach this goal, as evidenced by clinical experience and clinical trials; however, many clinicians and allied healthcare providers have not been trained in how to administer these therapies. This article demonstrates the successful implementation of therapeutic carbohydrate reduction for T2DM in an inpatient setting through the institutional example of a small, rural hospital in the U.S. It provides definitions for therapeutic carbohydrate reduction and a rationale for its use in an inpatient setting in patients who present with T2DM. The article outlines a seven-stage protocol developed from practice-based evidence to be used in an inpatient setting to minimize the requirement for insulin or other hypoglycemic medications and to normalize markers of T2DM in patients with this condition. The protocol consists of: 1) patient selection; 2) pre-diet evaluation and counseling; 3) patient education; 4) initiating the dietary intervention; 5) managing medication changes; 6) addressing any side effects; and 7) follow-up. This protocol serves as an initial framework for developing clinical practice guidelines and a standard of care for using carbohydrate reduction as an intervention for T2DM and related conditions in an inpatient setting. It also indicates the potential for providing clinicians with the opportunity to help patients put T2DM into remission, rather than just manage its progression. A Clinician’s Guide to Inpatient Low-Carbohydrate Diets for Remission of Type 2 Diabetes: Toward a Standard of Care Protocol.