Very low carbohydrate ketogenic diets and diabetes

Very low carbohydrate ketogenic diets (VLCKD) have been widely promoted for the management of diabetes. There is confusion among people with diabetes and health professionals about the efficacy and safety of these diets and this review aimed to explore the role of VLCKD for people with diabetes. An electronic search of English language articles was performed using MEDLINE (1980 to January 2020), EMBASE (1980 to January 2020) and the Cochrane Central Register of Controlled Trials (1980 to January 2020). Randomised controlled trials (RCTs) >12 weeks duration comparing VLCKD, defined as <50g carbohydrate/day, with higher carbohydrate intakes in people at risk of or with diagnosed diabetes were included. Primary outcomes included HbA(1c)and weight and secondary outcomes were lipid concentrations. There were no RCTs examining the role of VLCKD for diabetes prevention. Two RCTs in diagnosed type 2 diabetes reported significant weight loss, but outcomes for glycaemic control and lipid concentrations were inconsistent. There were no RCTs in people with type 1 diabetes, although observational trials reported lower HbA(1c), with a high prevalence of dyslipidaemia and hypoglycaemia. A lack of high-quality evidence limits the use of VLCKD in people with diabetes. Copyright (c) 2020 John Wiley & Sons.