Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an
intuitively attractive approach to the management of obese patients with type 2 diabetes. We
previously reported that a 20% carbohydrate diet was significantly superior to a 55–60%
carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes
patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we
reported maintenance of these gains after 22 months. The present study documents the degree to
which these changes were preserved in the low-carbohydrate group after 44 months observation
time, without close follow-up. In addition, we assessed the performance of the two thirds of
control patients from the high-carbohydrate diet group that had changed to a low-carbohydrate
diet after the initial 6 month observation period. We report cardiovascular outcome for the low-
carbohydrate group as well as the control patients who did not change to a low-carbohydrate diet.