A Comparative Study Evaluating the Effectiveness Between Ketogenic and Low-Carbohydrate Diets on Glycemic and Weight Control in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

Diabetes mellitus (DM) has become a worldwide public health burden and a significant cause of motility and morbidity. The most common type of diabetes is type 2 diabetes, which is estimated to have a prevalence of one in every ten adults living with diabetes in the United States. The risk factors for type 2 diabetes are obesity and being overweight. Therefore, the primary strategy used to manage type 2 diabetes is weight loss. Different measures, such as dietary therapies and physical training, have been used to manage type 2 diabetes through weight and glycemic control. The dietary therapies used to manage type 2 diabetes are ketogenic and low-carbohydrate diets. Despite studies showing that both ketogenic and low-carbohydrate diets significantly impact weight and glycemic control, the difference between the two diets has not been fully established. Therefore, this systematic review has demonstrated and compared the effectiveness of ketogenic and low-carbohydrate diets on glycemic and weight control. The literature search was conducted on five electronic databases, PubMed, ScienceDirect, Embase, Web of Science, and Google Scholar, from 2000 to 2022. Specified keywords related to the ketogenic diet (KD), low carbohydrates, and type 2 diabetes were used to search for relevant and original articles. The identified articles were analyzed using the eligibility criteria before they were included in the study. The eligibility criteria yielded 15 studies that were included in this systematic review. The results obtained by conducting a meta-analysis showed that low-carbohydrates had a greater reduction in the HbA1c than other diets (standardized mean difference [SMD]: -0.27%; 95% CI; -0.60%, 0.07%: P = 0.008, I2 = 66%). Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001). The results also show that the KD significantly impacts weight loss than control diets. The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet. Therefore, we can summarize that the KD is a more effective dietary therapy. However, there is a need to balance the weight loss and glycemic control benefits obtained from the KD with the increased cardiovascular risks for patients with type 2 diabetes.

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

“…This hypothesis was supported since the pooled effect showed that KD significantly reduced the body weight of patients with T2DM by 1.91 kg. These results are consistent with our previous meta-analysis, which reported a 2.67 kg weight reduction for patients following the KD protocols [35]. Similarly, a previous metaanalysis of four randomized trials reported a significant weight loss among T2DM patients following the KD protocol than patients subjected to other diets (SMD: -4.26kg; 95% CI; -6.88 kg, -1.63 kg; p = 0.001; I2 = 81%) [36].…”

“…The results of the current meta-analysis have also shown that KD has an insignificant difference compared with control diets in BMI reduction (p=0.49). These results are reinforced by our previous meta-analysis, which reported an insignificant difference in BMI between patients following the KD and other dietary interventions (SMD: -0.31 kg/m2; 95% CI; -0.81 kg/m2, 0.20 kg/m2; P=0.23, I2 = 84%) [ 35 ]. Choi YJ et al also reported that KD had an insignificant reduction in BMI compared with control interventions (SMD: -0.63 kg/m2; 95% CI; -1.31 kg/m2, 0.08 kg/m2; P = 0.08, I2 = 87%) [ 37 ].…”

Chronic Positive Mass Balance is the Actual Etiology of Obesity: A Living Review

“…A recent meta-analysis by Zaki et al compared the effectiveness between very-low-carbohydrate diets and lowcarbohydrate diets [20]. In this comparison, there is not such a significant difference in nutrient mass intake as in the aforementioned meta-analysis.…”

Chronic Positive Mass Balance is the Actual Etiology of Obesity: A Living Review

“…Let me remind you that when the energy fraction from dietary fat increases, while energy intake is fixed, mass intake decreases due to the significantly higher energy density of fat compared with other energy substrates. A recent meta-analysis by Zaki et al compared the effectiveness between very-low-carbohydrate diets and lowcarbohydrate diets [20]. In this comparison, there is not such a significant difference in nutrient mass intake as in the aforementioned meta-analysis.…”