SGLT2 Inhibitors Versus Intensive Low-Carbohydrate Dietary Programs for Glycemic Control and Early Detection of Renal Outcomes in Type 2 Diabetes

Abstract

Background:
Type 2 diabetes is highly prevalent and frequently complicated by chronic kidney disease. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and intensive low-carbohydrate dietary programs both improve glycaemia, but their comparative effects on early renal outcomes remain uncertain.
Methods:
A systematic search of PubMed and trial registries identified randomized and cohort studies in adults with type 2 diabetes evaluating SGLT2i or intensive low-carbohydrate programs versus usual care or higher-carbohydrate diets. Two reviewers independently screened records, extracted data, assessed risk of bias, and performed narrative synthesis.
Results:
Of 1,462 records, 9 studies (6 trials, 3 cohort/real-world; >19,000 participants) met inclusion criteria. Intensive low-carbohydrate programs produced larger short-term HbA1c reductions (−0.6 to −1.3 percentage points at 3–12 months) and 7–12 % weight loss, often allowing major de-intensification or discontinuation of insulin. SGLT2i yielded more modest but durable HbA1c reductions (−0.3 to −0.6 percentage points) and 2–4 kg weight loss with blood-pressure lowering. Across outcome trials and cohorts, SGLT2i reduced composite renal endpoints by about 30–40 % (hazard ratios =0.60–0.70; 95 % confidence intervals excluding 1.00), whereas low-carbohydrate interventions appeared renally neutral over 1–2 years.
Conclusions:
Both SGLT2i and intensive low-carbohydrate programs improved glycaemic control and cardiometabolic risk in adults with type 2 diabetes, but only SGLT2i showed robust renoprotective effects. These strategies may be complementary, and choice should consider renal risk, obesity, treatment goals, and capacity for sustained dietary change.