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Clinical Audit
Use of a very low carbohydrate diet for prediabetes and type 2 diabetes: An audit
Mariela Glandt, Nir Y. Ailon, Slava Berger, David Unwin
Journal of Metabolic Health | Vol 7, No 1 | a87 | DOI: https://doi.org/10.4102/jmh.v7i1.87


Abstract
Background: Type 2 diabetes (T2D) is viewed as a progressive chronic condition, yet recent research has raised hopes for reversal of this trajectory through innovative approaches.
Aim: This audit assessed the impact of a very low carbohydrate ketogenic diet (VLCKD) on glucose control, weight and medication usage in T2D and prediabetes patients. The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.
Setting: The Glandt Center for Diabetes Care, in Tel Aviv, Israel, from 2015 to 2022.
Methods: A cohort of 344 T2D or prediabetes patients following a VLCKD diet for 6 months at a specialised diabetes centre was analysed. Patient records were reviewed for glucose control, weight, blood pressure, lipid profile, liver function and medication usage, with paired t-tests used for analysis.
Results: Patients (mean age: 62 years; T2D duration: 12.3 years) showed significant improvements. Among patients with diabetes (N = 244), median HbA1c dropped from 59 mmol/mol (7.6%) to 45 mmol/mol (6.3%), with 96.3% showing improvement. Prediabetes patients (N = 100) experienced a drop from 42 mmol/mol (6%) to 38.7 mmol/mol (5.7%), with 84% improving. Weight loss occurred in both groups (median changes: −6.5 kg and −5.7 kg). Blood pressure, triglycerides and liver enzymes also improved. Initially, 78 patients were on insulin, reduced to 16 patients at 6 months, with average dose of those remaining on insulin reduced by 72%.
Conclusion: Very low carbohydrate ketogenic diet is effective in enhancing glucose control, weight loss and cardiovascular risk factors in T2D. Most patients achieved insulin independence, with others significantly reducing insulin dosage. The study underscores the potential of integrating a VLCKD with medication management in comprehensive T2D treatment.
Contribution: The audit shows the application of a KD in patients with long-standing diabetes.

This early success in one of the United States's poorest and sickest neighborhoods should give us hope that type 2 diabetes need not to be a progressive irreversible disease, even among the disadvantaged.

OwnaHealth's track record, along with that of Virta and other similar low-carbohydrate medical practices also give hope to the Food-Is-Medicine idea. Diabetes can go into remission, and people can be healed, provided that health practitioners prescribe the right foods. And in truth, it's not a diet. It's a way of eating that must be maintained. The sustainability of low-carbohydrate diets has been a point of contention, but the Virta trial, with 38% of patients sustaining remission at 2 years, showed that it's possible. (OwnaHealth, for its part, offers long-term maintenance plans to help patients stay very low-carb permanently.)

Given the tremendous costs and health burden of diabetes, this approach should no doubt be the first line of treatment for doctors and the ADA. The past two decades of clinical trial research has demonstrated that remission of type 2 diabetes is possible through diet alone. It turns out that for metabolic diseases, only certain foods are truly medicine.