Ketogenic Diets Potentially Reverse Type 2 Diabetes Via Continuous Remote Care Intervention: A Case Study in Central China

Abstract

Abstract Objectives Type 2 diabetes (T2D) remains a major public health challenge worldwide. Ketogenic diets (KD) have been reported to be effective in managing T2D, yet it is unclear if KD-based T2D management is suitable for patients in the central region of China where high-carbohydrate diets prevail. Here, an overweight T2D patient from Zhengzhou (Henan province), were enrolled in a 12-week KD-based continuous remote care intervention program. Methods Our 12-week intervention program is consisted of remote nutritional education, online personal coaching, and continuous monitoring of major biomarkers, e.g., body weight, blood pressure, continuous flash glucose monitoring, beta-hydroxybutyrate (BHB). The participant was advised to achieve and sustain nutritional ketosis through carbohydrate restriction since the onset of the study, and was instructed to reduce or stop diabetes medications within targeted continuous glucose levels, and to adjust carbohydrate intake in case of hypoglycemia. Results In 12 weeks, the participant (male; 52 years old) achieved a weight loss of 7.4 kg (from 90.1 kg to 82.7 kg), with waist circumference reduced from 103 cm to 97 cm and body mass index (BMI) reduced from 29.42 kg/m2 to 26.50 kg/m2; his HbA1c level and fasting glucose was reduced from 6.2% and 6.78 mmol/L at baseline to 5.8% and 5.48 mM/L repectively, with his fasting insulin decreased from 13.41 mM/L at baseline to 8.40 μIU/mL, HOMA-IR from 4.04 to 2.03, and an ideal ambulatory glucose profile (AGP) (Time in Range (TIR) ≧ 99%). The participant was advised to discontinue all diabetes medications after 1 week. During the 4th week, hypoglycemic events were detected, and the participant was advised to adjust carbohydrate intake; no hypoglycemic events were observed afterwards. Biomarkers related to blood lipids, lipoproteins, liver, kidney, thyroid and inflammation remained normal after the intervention. Conclusions Our results suggest that a 12-week KD-based continuous remote care intervention program featuring continuous flash glucose monitoring, can be effective and safe with high-level adherence in reversing T2D in a Chinese patient from central China. Funding Sources P.L. was supported by the National Natural Science Foundation of China (U1904158, U1604178) and the National high-tech developmental zone fund.