Plain language summary
Lifestyle interventions, in particular nutrition and exercise, are the initial treatment options recommended for newly diagnosed type 2 diabetics in the U.S.A. and Europe. The aim of this systematic review and meta-analysis was to evaluate the effect of a ketogenic diet (KD) on glycaemic control, body weight, cardiovascular risk factors, liver and renal function markers in adults with type 2 diabetes (T2DM). 11 randomised controlled trials with a total of 541 patients with T2DM were included in this review. Follow-up periods ranged from 4 to 104 weeks. There were no overall significant effects on glycaemic and anthropometric parameters, C-reactive protein (a marker of inflammation), endothelial function (measured as flow-mediated dilatation), blood pressure, renal or liver function markers. A significantly greater increase in HDL cholesterol and decrease in triglycerides was seen with the KD compared to control diets. The authors considered the KD to be a safe and effective alternative to glycaemic control and weight loss for patients with T2DM.
Abstract
OBJECTIVE To systematically review the effects of the ketogenic diet on glycaemic control, body weight, cardiovascular risk factors, and liver and kidney function in patients with type 2 diabetes. METHODS PubMed, MEDLINE, Embase, Cochrane Library and CINAHL were searched for randomised controlled trials published between 2001 and 2021 that compared the ketogenic diet to a control diet for effects on glycaemic control, body weight, cardiovascular risk factors, liver and renal function markers in adults with type 2 diabetes for >14 days. Meta-analyses using fixed or random effects models were conducted. RESULTS Nineteen reports from 11 randomised controlled trials were included. Compared to the control, the ketogenic diet showed no significant difference in changes in glycaemic control or body weight, but greater increases in HDL (standardised mean difference 0.19; 95%CI 0.02-0.37; I2 = 0 %; moderate-quality evidence) and greater reductions in triglycerides (standardised mean difference -0.41; 95%CI -0.64 to -0.18; I2 = 0 %; low-quality evidence). CONCLUSIONS The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.
Methodological quality
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