The ketogenic diet — there’s an app for that!

A 2017 report from the CDC states that just under 10% of Americans have type 2 diabetes and about 34% have prediabetes. In other words, almost half of the US population has some degree of insulin resistance and the accompanying glucose dysregulation. And things are expected to get worse: both estimates are expected to rise in the U.S.^[1] and other developed^[2] countries by 2030.

Having diabetes drastically reduces quality of life^[3], both physically and mentally, but it isn’t usually what kills someone. Rather, cardiovascular diseases (CVD) are the leading cause of death^[4] in people with type 2 diabetes. That’s because diabetes brings about^[5] several strong CVD risk factors, including dyslipidemia^[6], inflammation^[7], and hypertension^[8].

Adherence to lifestyle^[9] interventions, including diet, has been associated with both prevention of CVD development and CVD death in people with type 2 diabetes. The American Diabetes Association^[10] recommends a lifestyle management approach encompassing education, nutritional therapy, promotion of physical activity, smoking cessation counseling, and psychosocial care. However, the type of nutritional therapy that best manages diabetes remains an area of controversy.

Currently, conventional diabetes management focuses on carbohydrate counting and weight loss, usually through low-glycemic^[11] or moderate-carbohydrate diets. However, a growing base^[12] of research has supported the use of a non-medical ketogenic diet for facilitating weight loss while helping to regulate blood glucose and insulin levels. A ketogenic diet generally requires a carbohydrate intake of less than 50 grams per day, as shown in Figure 1.

Despite biological plausibility for why a ketogenic diet would benefit people with type 2 diabetes, as well as preliminary clinical trials showing its success in the real-world, acceptance of a ketogenic diet approach has been reluctant. The study under review sought to add to the body of evidence investigating the real-world effects of a ketogenic diet in people with type 2 diabetes.

Type 2 diabetes affects a significant number of people in developed countries and continues to become more prevalent. Lifestyle interventions focused on weight loss can successfully manage the disease. The diet component of these lifestyle interventions is usually some form of a low-glycemic diet, and growing evidence suggests that a ketogenic diet may be a suitable alternative. The study under review sought to evaluate the effectiveness of a ketogenic diet under real-world conditions in people with type 2 diabetes.