The number of people with diabetes has quadrupled since 1980. The CDC estimates that over 30 million Americans live with diabetes, and it is among the leading causes of death. Although diet and weight loss can improve type 2 diabetes (T2D), few people achieve this with the current standard of care. Long-term results are especially poor.

But a new long-term study has shown dramatic improvement and, in fact, reversal of T2D. The treatment protocol was revolutionary because it used diet rather than medication.

The study included 262 adults with T2D. They had a mean age of 54 years, 92 percent were obese, and 88 percent were on prescription diabetes medication. A control group of similar demographics received the usual T2D care model. The primary outcome measures were glycosylated hemoglobin (HbA1c), weight, and medication use.

The treatment protocol for the study was nutritional ketosis (i.e., a ketogenic diet). Subjects also received remote medical monitoring and biometric feedback. The study length was one year.

The biometric feedback included monitoring of body weight, blood glucose, and blood ketones. Subjects received education and communication with their telemedicine healthcare providers by app. These healthcare providers included a health coach (i.e. dietitian or other nutrition-trained provider) and a physician. The healthcare team monitored and adjusted diet and medication. Social support was provided by an online support community.

Subjects received individualized nutrition recommendations for achieving ketosis. Specific goals for blood ketones (beta-hydroxybutyrate) were adjusted within the range of 0.5-3.0 mmol/L based on biomarkers as well as hunger, cravings, energy, and mood. Typically, dietary carbohydrate intake was less than 30g/day. Protein and fat intake was also monitored and adjusted. The diet also included three to five daily servings of non-starchy vegetables, adequate mineral and fluid intake, a multivitamin, vitamin D3, and supplemental omega-3. Electrolytes were supplemented as needed.

The results were unprecedented. The control group reached significant improvement at 70 days. Then they continued to improve over the duration of the study. At the one-year point, the study group had lowered their HbA1c from 7.6 percent to 6.3 percent, while the control group had no change. The study group lost 12 percent of their body weight, an average of 30.4 lb (13.8 kg). The control group did not lose weight. Among the study group subjects who began on insulin, 94 percent were able to stop. All subjects on sulfonylurea medications were able to stop. Overall medication use (excluding metformin) dropped from 57 percent to 30 percent of subjects. On the other hand, the control group had no change in total medication use. In fact, their average insulin use increased.

Importantly, the control group experienced no adverse outcomes. Adherence was high, with a 16.8 percent dropout rate. Other improvements enjoyed by the control group included improved blood lipids, lower inflammation, and improved liver function.

This study showed that nutritional ketosis combined with medical monitoring, support, and biofeedback is incredibly effective for D2M treatment. It is significantly more effective than the standard treatment model. Importantly, this treatment modality is safe and sustainable over the long term. Of course, medical advice and monitoring is critical for T2D patients attempting a ketogenic diet, since medication dosing will need to be adjusted.