Discussion
weight loss, T2DM
This study was the first to assess the effect of a LCD (10–<26% total energy intake from carbohydrate) provided in a web-based setting for people with T2DM using an RCT design. In this study, the web-based T2Diet programme provided in conjunction with standard care resulted in significant reductions in HbA1c, weight, BMI, and anti-glycaemic medication requirements compared with standard care alone. Our findings are consistent with previous meta-analyses of face-to-face LCD interventions in people with T2DM, where reductions in HbA1c, weight, BMI, and medication requirements have been repeatedly noted [The results supported our hypothesis that the intervention group would achieve lower HbA1c at 16 weeks, with a mean between-group difference of −0.65%, which is a clinically meaningful reduction [Without dietary or lifestyle modification, the primary method to assist patients to attain glycaemic control is through prescription of anti-glycaemic medication [In the current study, the intervention was not specifically designed to achieve weight loss, as intervention group participants were able to consume foods ad libitum. The overall mean daily energy intake was consistent with the estimated daily energy intake recommended for the demographic in this study [In terms of dietary intake, participants in the intervention group consumed 24.7% total energy intake from carbohydrates, indicating acceptable adherence to the recommended LCD (10–<26%). In previous reviews of LCD RCTs, comparative nutritional breakdowns have indicated significant reductions in dietary fibre and increases in saturated fat [Although self-efficacy did increase in the intervention group and decrease in the control group, the intervention effects observed did not appear to be mediated by changes in self-efficacy but could have been brought about by other determinants not examined, such as increased knowledge, motivation, and/or intentions.Several limitations of this study were previously noted in our published protocol [