The case is a 78-year-old male with type 2 diabetes (T2D) and hypertension treated by empagliflozin, metformin, amlodipine and telmisartan. HbA1c increased 5.4% to 7.4% in 2021-2022. By imeglimin (Twymeeg), HbA1c decreased to 6.3% for 8 months. Large studies were found as Trials of IMeglimin for Efficacy and Safety (TIMES) 1, 2 and 3. After that, HbA1c was elevated to 7.8% in April 2023. Then vildagliptin/metformin (EquMet) was started, and HbA1c decreased to 5.4% with 8kg weight reduction for 6 months. Thus, authors have continued to develop activities of low carbohydrate diet (LCD) through Japan LCD promotion association (JLCDPA).