Can a ketogenic diet affect patients newly diagnosed with type 2 diabetes that are obese or overweight?

This study observed the effectiveness of a ketogenic diet (KD) in patients newly diagnosed with type 2 diabetes (T2D) that were overweight or obese. The authors concluded that a DK can control body weight, blood glucose, and blood lipids (fats) in these patients but long-term adherence is a challenge.

T2D is a chronic disease that results in a patient’s inability to make insulin or to adequately utilize it for blood glucose control. Obesity or overweight is defined by a higher than normal (over 25 kg/m²)body mass index (BMI; weight in relation to height). A higher BMI increases the risk of occurrence of T2D.

Blood glucose and body weight may be controlled by a very low carbohydrate diet, adequate sleep, and exercise in patients with T2D. A ketogenic diet (KD) consists of very low levels of carbohydrates (carbs) and high amounts of fats with adequate quantities of protein. This leads to fat-burning to use as energy instead of carbs. 

It is important to evaluate if a KD can affect blood indicators in patients with obesity or overweight and T2D.

This study included 60 newly diagnosed patients with T2D that were overweight or obese. They were randomly assigned to 2 groups. One group received a KD that mainly consisted of olive oil, butter, fried eggs, double-fried pork, pan-fried salmon, pacific saury, sardines, broccoli, and avocado. Daily limits included 30-50 g of carbs, 60 g of protein, 130 g of fat, and 1450-1550 kcal per day. The other group received a standard diabetes diet (control diet; CD). This consisted of 250-280 g of carbs, 60 g of protein, 20 g of fat, and 1450-1550 kcal per day. BMI, waist circumference, triglycerides, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), fasting glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c) were measured. Patients were followed for 12 weeks.

After 12 weeks, 6 people in the KD group stopped the study for lack of adherence compared to 1 patient in the CD group. Weight, BMI, waist circumference, TG, TC, LDL, HDL, FBG, FINS, and HbA1c were decreased in both groups. Significant decreases were greater in the KD group compared to the CD group.

The study indicated that while a KD diet can better control body weight, blood glucose, and blood lipids, adherence may be a long-term issue in newly diagnosed patients with T2D.

The study had a short follow-up period. Serum uric acid buildup occurred with the KD, potentially increasing the risk for gout. The study was based on a particular ethnic population.