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Ketogenic diets and type 2 diabetes

According to the International Diabetes Federation (IDF) 540 million people worldwide live with diabetes, and by 2045, IDF projections show that 1 in 8 adults, approximately 783 million, will be living with diabetes, an increase of 46%. Over 90% of people with diabetes have type 2 diabetes, which is driven by socio-economic, demographic, environmental, and genetic factors [1]. 

The key contributors to the rise in type 2 diabetes include:

  • Urbanization
  • Aging 
  • Low levels of physical activity
  • Overweight or obesity 

Diabetes is a major health concern that is accompanied by a long list of complications such as increased risk of microvascular pathology of the retina, renal glomerulus, peripheral neuropathy, and atherosclerotic disease affecting arteries. Many of these diabetic complications have been linked to elevated levels of glucose over long periods of time. Type 2 diabetes is caused by hyperinsulinemia and insulin levels are directly affected by carbohydrate consumption [2]. 

As the main issue in diabetes is the inability to manage blood glucose levels, one approach to it is to restrict carbohydrate consumption. Generally, people get 50 to 60% of their daily calories from carbohydrates. To manage or prevent diabetes, low-carb and ketogenic diets are recommended. 

Ketogenic diets were designed to treat epilepsy over a 100 years ago. Our knowledge on the benefits of ketosis have expanded and now this kind of metabolic therapy is being

studied and utilized for the management of diverse medical conditions, such as migraines, obesity, bipolar disorder, Alzheimer’s disease, certain types of cancer, insulin resistance and diabetes.

Source of the image: Dowis, & Banga, 2021

Insulin resistance

In prediabetes and type 2 diabetes, insulin is being produced, but the cells are resistant to the hormone. For people with prediabetes, a low-carb diet could quickly bring elevated A1C levels back to a healthier range 1. In a study published in 2022, patients were asked to keep carbohydrate consumption below 40 grams a day for three months. During months four through six, their carb limit was below 60 grams a day. Compared to those eating their usual diet, participants taking the low-carb approach had greater improvements in A1C and fasting blood glucose levels at the six-month mark. They also lost an average of 5,8kg. The A1C improvements represented nearly a 60% lower risk for developing diabetes within the next three years [3].

For people who are already diabetic the diet is even more important due to enormous risks to the heart, brain, kidneys, nerves and vision. A meta-analysis published in 2022 showed that the ketogenic diet is more effective in reducing glycated hemoglobin and body weight (BW) than a low-carbohydrate diet for patients with type 2 diabetes. It greatly improves  blood sugar levels, reduces glycated hemoglobin levels, contributes to reducing adiposity, reduces the amount of diabetic medications to be taken, and improves quality of life in general [4].


[1] IDF Diabetes Atlas 2021. 

[2] Dowis, K.; Banga, S. The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients 2021, 13, 1654. 

[3] Dorans KS, Bazzano LA, Qi L, et al. Effects of a Low-Carbohydrate Dietary Intervention on Hemoglobin A1c: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(10):e2238645. doi:10.1001/jamanetworkopen.2022.38645 

[4] Zaki HA, Iftikhar H, Bashir K, Gad H, Samir Fahmy A, Elmoheen A. A Comparative Study Evaluating the Effectiveness Between Ketogenic and Low-Carbohydrate Diets on Glycemic and Weight Control in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus. 2

022 May 31;14(5):e25528. doi: 10.7759/cureus.25528. PMID: 35800806; PMCID: PMC9246466.

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