Use of a very low carbohydrate diet for prediabetes and type 2 diabetes: An audit

Abstract

Background: Type 2 diabetes (T2D) is viewed as a progressive chronic condition, yet recent research has raised hopes for reversal of this trajectory through innovative approaches.

Aim: This audit assessed the impact of a very low carbohydrate ketogenic diet (VLCKD) on glucose control, weight and medication usage in T2D and prediabetes patients. The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.

Setting: The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.

Methods: A cohort of 344 T2D or prediabetes patients following a VLCKD diet for 6 months at a specialised diabetes centre was analysed. Patient records were reviewed for glucose control, weight, blood pressure, lipid profile, liver function and medication usage, with paired t-tests used for analysis.

Results: Patients (mean age: 62 years; T2D duration: 12.3 years) showed significant improvements. Among patients with diabetes (N = 244), median HbA1c dropped from 59 mmol/mol (7.6%) to 45 mmol/mol (6.3%), with 96.3% showing improvement. Prediabetes patients (N = 100) experienced a drop from 42 mmol/mol (6%) to 38.7 mmol/mol (5.7%), with 84% improving. Weight loss occurred in both groups (median changes: −6.5 kg and −5.7 kg). Blood pressure, triglycerides and liver enzymes also improved. Initially, 78 patients were on insulin, reduced to 16 patients at 6 months, with average dose of those remaining on insulin reduced by 72%.

Conclusion: Very low carbohydrate ketogenic diet is effective in enhancing glucose control, weight loss and cardiovascular risk factors in T2D. Most patients achieved insulin independence, with others significantly reducing insulin dosage. The study underscores the potential of integrating a VLCKD with medication management in comprehensive T2D treatment.

Contribution: The audit shows the application of a KD in patients with long-standing diabetes.