A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy

Sabine Kleissl-Muir; Bodil Rasmussen; Alice Owen; Caryn Zinn; Andrea Driscoll

doi:10.1530/EDM-23-0086

A low-carbohydrate diet in place of SGLT2i therapy in a patient with diabetic cardiomyopathy

Endocrinol Diabetes Metab Case Rep. 2023 Dec 13;2023(4):23-0086. doi: 10.1530/EDM-23-0086. Print 2023 Oct 1.

Authors

Sabine Kleissl-Muir¹, Bodil Rasmussen^{1

2

3

4

5}, Alice Owen⁶, Caryn Zinn⁷, Andrea Driscoll^{1

2

6

8}

Affiliations

¹ Deakin University School of Nursing and Midwifery, Geelong, Victoria, Australia.
² School of Nursing and Midwifery, Centre for Quality and Patient Safety, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.
³ The Centre for Quality and Patient Safety, Institute of Health Transformation -Western Health Partnership, Western Health, St Albans, Victoria, Australia.
⁴ Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁵ Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Centre, Odense M, Denmark.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
⁸ Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia.

Abstract

Summary: In patients with diabetes mellitus, the toxic milieu caused by abnormal glucose and free fatty acid handling can lead to heart failure (HF). Referred to as diabetic cardiomyopathy (DMCM), this syndrome often exists in the absence of conventional risk factors for HF such as history of myocardial infarction or hypertension. Low-carbohydrate diets (LCDs) have recently been endorsed as an efficacious therapeutic dietary approach to prevent and reverse cardiometabolic disease including type 2 diabetes mellitus (T2DM). LCDs improve systemic insulin resistance (IR), reverses cardiac remodelling in a rodent model and downregulates the expression of sodium-glucose co-transporter 2 (SGLT2) receptors in the kidney. It is therefore conceivable that a lifestyle approach such as adopting an LCD can be offered to patients with DMCM. The reported case is that of a 45-year-old man with a 15-year history of non-ischaemic cardiomyopathy, T2DM and obesity. The patient volunteered to engage in a 16-week low-carbohydrate dietary intervention trial and then self-selected to remain on this diet for 1 year. The whole-food LCD was based on simple 'traffic light' style food lists and not designed to restrict calories, protein, fat or salt. After 1 year, the patient had lost 39 kg and his cardiometabolic markers had significantly improved. LCDs present a potentially beneficial approach for patients with DMCM and could be considered as a lifestyle intervention before SGLT2i therapy is commenced.

Learning points: Diabetic cardiomyopathy (DMCM) is a syndrome precipitated mainly by the detrimental effects of glucose metabolism disorders such as insulin resistance and diabetes. Low-carbohydrate diets (LCD) mimic many effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i). LCDs are a dietary pattern which can have significant and beneficial effects on metabolic and anthropometric markers in patients with DMCM. LCDs and SGLT2i therapy could be combined and may achieve better clinical outcomes for patients with DMCM. Combination therapy may be carried out under close supervision as the real risk for diabetic ketoacidosis remains.