Type 2 diabetes mellitus: individualizing the dietary plan: When to choose a ketogenic diet versus intermittent fasting?

Abstract

The nutritional recommendations of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) include low-carbohydrate diets (LWD) among meal plans 1. The ketogenic (CD) diet, also called the Keto diet, is a type of DBCH that restricts the total daily amount of CH to < 50 g, or less than 10% of daily calories, with 70-80% of calories derived from fat¹, the primary source of fuel. As a result, a state of ketosis is established with the consequent decrease in blood glucose levels.

Recent meta-analyses of randomized controlled trials consistently demonstrated the efficacy of CD in glycemic control and stability (fasting glycemia/HbA1c), reduced body weight, and increased insulin sensitivity, in people with type 2 diabetes (PDT2) and overweight/obesity compared to other diets^2,3. In adults with T2D, evidence shows that CD is safe 1, and the approach is individualized by assessing the risks and benefits. A possible risk of CD is hypoglycemia, which involves periodic medical supervision and adjustment of the insulin therapy plan and antidiabetic drugs, to minimize its appearance. A major challenge of CD in PDT2 is long-term adherence⁴ and commits to regular re-evaluation^2,3. CD, as an option to be considered within the dietary approach to PDT2, is effective in reducing HbA1C and the requirement for antihyperglycemic drugs. In the coming years, there will be information available about the factors that determine which people would benefit from a specific dietary approach, assessing the behavioral, cultural and environmental characteristics that are conditioning factors for success in building healthier lifestyle habits, individualizing the food plan.