title: A low-carbohydrate, ketogenic diet to treat type 2 diabetes.
abstract: BACKGROUND
  The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.
  
  
  METHODS
  From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c.
  
  
  RESULTS
  Twenty-one of the 28 participants who were enrolled completed the study. Twenty participants were men; 13 were White, 8 were African-American. The mean [+/- SD] age was 56.0 +/- 7.9 years and BMI was 42.2 +/- 5.8 kg/m2. Hemoglobin A1c decreased by 16% from 7.5 +/- 1.4% to 6.3 +/- 1.0% (p < 0.001) from baseline to week 16. Diabetes medications were discontinued in 7 participants, reduced in 10 participants, and unchanged in 4 participants. The mean body weight decreased by 6.6% from 131.4 +/- 18.3 kg to 122.7 +/- 18.9 kg (p < 0.001). In linear regression analyses, weight change at 16 weeks did not predict change in hemoglobin A1c. Fasting serum triglyceride decreased 42% from 2.69 +/- 2.87 mmol/L to 1.57 +/- 1.38 mmol/L (p = 0.001) while other serum lipid measurements did not change significantly.
  
  
  CONCLUSIONS
  The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
authors.affiliation: Center for Health Services Research in Primary Care, Department of Veterans' Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705, USA. yancy006@mc.duke.edu
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.forename: Marjorie
authors.initials: M
authors.lastname: Foy
authors.forename: Allison M
authors.initials: AM
authors.lastname: Chalecki
authors.forename: Mary C
authors.initials: MC
authors.lastname: Vernon
authors.forename: Eric C
authors.initials: EC
authors.lastname: Westman