Clinical Audit

The application of carbohydrate-reduction in general practice: A medical audit

Marcus A. Hawkins, Caryn Zinn, Christine Delon
Journal of Metabolic Health | Vol 6, No 1 | a86 | DOI: | © 2023 Marcus A. Hawkins, Caryn Zinn, Christine Delon | This work is licensed under CC Attribution 4.0
Submitted: 03 July 2023 | Published: 08 December 2023

About the author(s)

Marcus A. Hawkins, Botany Doctor Medical Practice, Botany Town Centre, Auckland, New Zealand
Caryn Zinn, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
Christine Delon, NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, United Kingdom


Background: Carbohydrate-reduction has been used successfully in the management of conditions arising from insulin resistance.

Aim: In this audit, the authors report on metabolic outcomes from 72 patients in primary care who have undergone counselling using a low-carbohydrate dietary approach.

Setting: This audit took place in a family medical practice located in a relatively affluent suburb in East Auckland, New Zealand.

Methods: Patients adopted a carbohydrate reduction diet with regular follow-up and monitoring of health parameters.

Results: The mean duration of observation was 21.5 (± 10.4) months. On average, patients lost 11 (± 8.4) kg, with 17% attaining a healthy body mass index (BMI). Four out of five patients reversed prediabetes over 20.8 (± 13.4) months. Twenty-five per cent (28/113) of the practice population with type 2 diabetes (T2DM) participated, of which 64% reversed and 11% remitted T2DM over 20.7 (± 11.8) months. Two patients stopped insulin and 10 reduced or stopped other diabetes medications. Nearly 35% (25/72) of participants were initially hypertensive. Thirty-six per cent (9/25) normalised systolic blood pressure (SBP), 28% (7/25) normalised diastolic blood pressure (DBP), and 16% (4/25) normalised both SBP & DBP. Sixty-four per cent reduced or stopped some or all antihypertensive medication. There was a mean reduction in SBP of 10.3 (± 17.7) mmHg and DBP of 4.8 (± 12.3) mmHg over 23.8 (± 9.0) months. Lipid changes were generally favourable, with 52% normalising triglycerides, 61% increasing high density lipoprotein cholesterol (HDL-C) to greater than 1.0 mmol/L, and 39% reducing low density lipoprotein cholesterol (LDL-C).

Discussion: This real-world audit aligns with published data on the benefits of carbohydrate reduction.

Conclusion: Effective management of prediabetes using CR might represent the biggest ‘bang for buck’ with a potential reduction in weight and prevention of diseases related to IR.

Contribution: A low-carbohydrate dietary approach in primary care may serve as a realistic option for improving multiple health outcomes.


low-carbohydrate diets; diabetes remission; lifestyle modification; obesity treatment; type 2 diabetes; hypertension reversal; non-alcoholic fatty liver reversal; de-prescribing.

Sustainable Development Goal

Goal 3: Good health and well-being


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