Low-Carbohydrate and Ketogenic Dietary Patterns for Type 2 Diabetes Management.

Area of Science:

• Endocrinology and Metabolism
• Nutrition Science
• Clinical Medicine

Background:

• Type 2 diabetes mellitus (T2DM) traditionally viewed as chronic and progressive.
• US guidelines since 2017 incorporate low-carbohydrate (LC) diets for T2DM management.
• Renewed interest in carbohydrate restriction, including ketogenic diets, for T2DM management and remission.

Purpose of the Study:

• Review evidence for carbohydrate reduction in T2DM.
• Provide a practical guide for clinicians on therapeutic LC diets.
• Discuss medication management and deprescribing strategies alongside LC diets.

Main Methods:

• Narrative review of existing literature.
• Illustrative case presentation.
• Practical guidance on prescribing very low, low, and moderate LC diets (varying grams of carbohydrates).
• Discussion of adverse effects and management strategies.
• Medication management and deprescribing approaches.

Main Results:

• Improved glycemic control and sustained weight loss with effective LC diets and counseling.
• Potential for T2DM remission (HbA1c < 6.5% for ≥3 months without medication).
• Reduction in medication needs, including insulin.
• Identification of barriers and limitations in federal healthcare settings.

Conclusions:

• LC diets, combined with lifestyle counseling and safe medication management, can enhance glycemic control, reduce medication reliance, and promote weight loss.
• Therapeutic carbohydrate reduction shows promise for T2DM efficacy and continuation.
• Further research is needed on long-term effects on cardiometabolic risk, morbidity, and mortality.