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Ketogenic Diets in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Diabetes, Obesity and Metabolism

Published on 2022

Ketogenic Diets in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Summary

This systematic review and meta-analysis examines the effects of very low carbohydrate ketogenic diets (VLC/KDs) on glycaemic control, lipid profiles, and weight in individuals with type 2 diabetes. The study finds some evidence of improvement in HbA1c and triglycerides but highlights the need for more robust long-term research.

Study Design

Interventions

Very low carbohydrate ketogenic diet

Study Type

Systematic ReviewMeta-AnalysisRCTs

Outcomes

Reduction in HbA1cReduction in triglyceridesWeight loss

Duration and Size

Long-Term (1–5 y)

Medium size (100–500)

Study Population

Age Range

Middle Aged (40-64)

Sex

MaleFemale

Geography

Global

Other Criteria

with T2 Diabetes

Methodology

This systematic review and meta-analysis followed PRISMA guidelines and included randomized controlled trials (RCTs) that evaluated the efficacy of very low carbohydrate ketogenic diets (≤50 g carbohydrate per day) in adults with type 2 diabetes or pre-diabetes. The primary outcome measured was HbA1c at 12 months. The analysis involved inverse variance weighting of mean values for continuous variables. Studies reporting on metabolic markers, lipid profiles, and body composition were included. A total of 606 participants from eight studies met the inclusion criteria. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Studies varied in control diet composition, adherence rates, and duration.

Interventions

Participants followed very low carbohydrate ketogenic diets, defined as ≤50g carbohydrate or ≤10% total daily energy from carbohydrates. The control groups followed higher carbohydrate, low-fat diets, often calorie-restricted. Interventions varied in terms of fat and protein intake, with some studies emphasizing monounsaturated and polyunsaturated fats over saturated fats. Medication adjustments were applied variably across studies. Participants were encouraged to engage in physical activity.

Key Findings

The study found that very low carbohydrate ketogenic diets may improve glycaemic control (HbA1c reduction) and lipid profiles (triglyceride reduction) in individuals with type 2 diabetes. However, the evidence does not strongly suggest superiority over other dietary strategies. HbA1c reductions were inconsistent, and adherence to ketogenic diets may decline over time. The study recommends further well-designed, long-term studies to evaluate sustainability and clinical benefits.

Comparison with other Studies

Several systematic reviews and meta-analyses have evaluated the impact of very low-carbohydrate ketogenic diets (VLCKDs) on type 2 diabetes management. A 2021 BMJ meta-analysis found that VLCKDs could promote diabetes remission within six months, but benefits diminished over time due to adherence challenges. Similarly, a 2022 study in the International Journal of Environmental Research and Public Health reported improvements in body weight, HbA1c, and lipid profiles. However, a 2023 Clinical Nutrition review concluded that while ketogenic diets may enhance lipid profiles, they do not offer long-term advantages in glycemic control or weight loss compared to standard diets. Collectively, these findings suggest that VLCKDs may be effective for short-term weight and metabolic improvements, but their long-term sustainability and efficacy remain uncertain due to variations in adherence and study designs .

Journal Reference

Parry-Strong A, Krebs JD. Ketogenic diets in pre-diabetes and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2024;XX(X):XX-XX. doi:10.1111/dom.14837

This research summary and analysis were generated using AI-powered tools to assist in data synthesis and interpretation. While we strive for accuracy and completeness, we encourage readers to verify critical information and consult additional sources as needed. The insights presented reflect an AI-assisted perspective and should not be considered a substitute for expert opinion or independent research.

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