Can Ketogenic Diet or Intermittent Fasting Help Patients with DM2 in Controlling Weight and Glycemia?
The foundation of managing type 2 diabetes mellitus (DM2) typically involves lifestyle adjustments, including dietary changes. Can intermittent fasting (IF) or the ketogenic diet (KD), popular dietary trends, help diabetics with weight loss and reduction of glycated hemoglobin (HbA1c) levels? The answer was sought by authors of a systematic review and meta-analysis comparing IF or KD with other dietary regimes.
Evaluated Studies
The authors searched for relevant studies using electronic databases ScienceDirect, Google Scholar, PubMed, Scopus, Embase, and Web of Science as well as manually, looking at publications from 2000 to 2022. They identified 1,299 articles related to the issue, but only 12 met the inclusion criteria (after removing duplicates and checking for appropriate inclusion—excluding animal studies, evaluations without comparing IF or KD with another diet, or working with KD or IF in patients with diseases other than DM2, as well as texts published in languages other than English, abstracts only, or case reports). The quality of the studies was controlled using Review Manager software (RevMan 5.4.1).
Findings
Body Weight Reduction
Pooled data from 5 studies showed that KD led to a significantly greater reduction in body weight compared to other diets (mostly low-calorie diets) (standardized mean difference [SMD] –1.91 kg; 95% confidence interval [CI] –2.96 to –0.85 kg; p = 0.0004), but it reduced body mass index (BMI) compared to the control diet only insignificantly (SMD –0.24; 95% CI –0.93 to 0.45; p = 0.49).
Regarding IF, pooled data from 5 studies showed that the difference in weight loss was insignificant compared to control dietary interventions (Mediterranean diet, continuous calorie restriction) (p = 0.10). However, a meta-analysis of 3 studies showed that IF significantly reduced BMI compared to the control diets (SMD –0.40; 95% CI –0.68 to –0.11; p = 0.006).
Glycemic Control
Five studies evaluated the impact of KD on HbA1c levels. Their meta-analysis showed that KD resulted in a significantly greater reduction in HbA1c concentration compared to other diets (SMD –2.00%; 95% CI –3.76 to –0.25; p = 0.03). Conversely, pooled results from 4 studies evaluating IF showed that this strategy did not have a significantly greater effect on HbA1c compared to control dietary interventions (SMD 0.36%; 95% CI –0.37 to 1.10; p = 0.33).
Conclusion and Discussion
The authors state that the globally increasing prevalence of DM2 requires effective treatment in primary care and that ketogenic diets and intermittent fasting are among the methods with the potential to reduce the incidence and severity of DM2. According to the authors, these can help DM2 patients with weight loss and glycemic control. In the described study, IF reduced both parameters only insignificantly more than control diets. However, it led to a significantly greater reduction in BMI. KD appeared to be significantly more effective in weight reduction and lowering HbA1c levels compared to the diets it was compared with, but not in terms of BMI reduction.
The authors point out that despite the benefits of IF and KD in terms of bodyweight adjustment and glycemic control, these dietary regimes have potential adverse effects and should therefore be used cautiously and only under the professional supervision of healthcare providers.
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Source: Zaki H. A., Iftikhar H., Abdalrubb A. et al. Clinical assessment of intermittent fasting with ketogenic diet in glycemic control and weight reduction in patients with type II diabetes mellitus: a systematic review and meta-analysis. Cureus 2022 Oct 30; 14 (10): e30879, doi: 10.7759/cureus.30879.
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