Research Library

A Low-Carbohydrate, Ketogenic Diet for Type 2 Diabetes Mellitus

Yancy, W.S., Foy, M.E., Westman, E.C., "A Low-Carbohydrate, Ketogenic Diet for Type 2 Diabetes Mellitus," Journal of General Internal Medicine, 19(1S), 2004, page 110.

The following information is available at Pub Med and was not written by Atkins professionals.

Background: Low-carbohydrate diets lead to weight loss, and in one study led to improved glycemic control in diabetics. The objective of this pilot study was to examine the safety and effectiveness for glycemic control of the low-carbohydrate, ketogenic diet (LCKD) in patients with type 2 diabetes.

Methods:In a Veterans’ Affairs Medical Center outpatient clinic, we recruited overweight (body mass index [BMI] >25 kg/m2) subjects taking oral hypoglycemic agents and/or insulin, or having a hemoglobin A1c >6.0% without medication. Subjects received LCKD counseling, with an initial goal of <20 g carbohydrate/day, and were encouraged to take a multivitamin and drink 6-8 glasses of fluids daily. Diabetes medication dosages were reduced by approximately 50% at diet initiation; diuretic medications were reduced by 50% or discontinued, and subsequently reinstituted if needed. Subjects returned every other week for 16 weeks for body and vital sign measurements, counseling, and further medication adjustment if needed. Fasting blood and 24-hour urine tests were obtained at weeks 0, 8, and 16. Serum electrolytes and kidney function tests were monitored additionally at weeks 2 and 12.

Results: Nineteen of the 25 subjects who were enrolled completed the study. Eighteen subjects were men; 13 were White, 5 were Black. The mean [+ SD] age was 56 ± 8 years; mean BMI was 39 ± 6 kg/m2 (range 28-51 kg/m2). From baseline to week 16, hemoglobin A1c decreased by 15% from 7.4 ± 1.5% to 6.3 ± 1.1% (p<0.001) while diabetes medications were discontinued in 6 subjects, reduced in 7 subjects, and unchanged in 5 subjects. Mean body weight decreased by 7% from 131 ± 19 kg to 122 ± 20 kg (p<0.001). Fasting serum glucose decreased from 163 ± 70 mg/dL to 136 ± 48 mg/dL (p=0.05) and triglycerides from 242 ± 268 mg/dL to 144 ± 124 mg/dL (p=0.005). Changes in other serum lipid measurements were not statistically significant. One hypoglycemic attack requiring assistance occurred during the study. In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c.

 Conclusion:The LCKD reduced glycemia, body weight and serum triglycerides in type 2 diabetic patients but close medical supervision was required to adjust diabetic and blood pressure medications. Controlled trials are needed to determine the safety and effectiveness of this diet compared with conventional weight loss diets.

The following information was written by Atkins professionals.

The safety and effectiveness of a low-carbohydrate, ketogenic diet (LCKD) on improving glycemic control was examined in patients with type 2 diabetes. Participants were counseled to follow Induction (less than 20 grams of carbohydrate per day) and proceed to On-Going Weight Loss (increasing carbohydrate as tolerated). They were also instructed to take a multivitamin and consume 6-8 glasses of fluids daily. After 16 weeks, the 19 men and women completing the study had significant improvements in glycemic control (HbA1c decreased 15%) and triglyceride levels, a significant weight loss of 7%, and improvements in fasting serum glucose. Diabetes medications were discontinued or reduced in 13 of the participants. Results indicate that type 2 diabetics may benefit from a LCKD, as body weight and triglycerides were reduced, and improved glycemic control enabled participants to use less medication. It is important to note that close medical supervision was provided to ensure medications were adjusted appropriately.