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Published: 15 November 2023
Does a Ketogenic Diet Have a Place Within Diabetes Clinical Practice? Review of Current Evidence and

Abstract
Carbohydrate restriction has gained increasing popularity as an adjunctive nutritional therapy for diabetes management. However, controversy remains regarding the long-term suitability, safety, efficacy and potential superiority of a very low carbohydrate, ketogenic diet compared to current recommended nutritional approaches for diabetes management. Recommendations with respect to a ketogenic diet in clinical practice are often hindered by the lack of established definition, which prevents its capacity to be most appropriately prescribed as a therapeutic option for diabetes. Furthermore, with conflicted evidence, this has led to uncertainty amongst clinicians on how best to support and advise their patients. This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies.

Key Summary Points
-Ketogenic diets has gained significant popularity recently however controversy still exists whether this should be used as a first line treatement for people with diabetes.

-Ketogenic diets have favourable metabolic and weight reduction effects in the short term in people living with diabetes, primarily in type 2 diabetes (T2D) with emerging evidence in type 1 diabetes.

-Systematic reviews and meta-analyses reiterate that ketogenic diets are not superior but not inferior in terms of metabolic advantages for diabetes management.

-There is an urgent unmet need for long-term data of health outcomes comparing conventional and ketogenic diets.

-There remains an absence of a univocal definition of a ketogenic diet which continues to hinder research and clinical implementation of ketogenic for diabetes management.