Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin New England Journal of Medicine

This research involved over 3000 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations receiving placebo, metformi/n (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The study found that lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk, and that the lifestyle intervention was more effective than metformin.

10-year Follow-up of Diabetes Incidence and Weight Loss in the Diabetes Prevention Program Outcomes Study – The Lancet

In the 2.8 years of the Diabetes Prevention Program (DPP) randomized clinical trial, diabetes incidence in high-risk adults was reduced by 58% with intensive lifestyle intervention and by 31% with metformin, compared with placebo. In this follow-up study, cumulative incidence of diabetes was found to remain lowest in the patients who received lifestyle intervention. The study concluded that Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years.

Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetesAnnals of Internal Medicine

In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels.

Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes – Cell Metabolism

This research studied early time-restricted feeding (eTRF), a form of Intermittent Fasting that involves eating early in the day to be in alignment with circadian rhythms in metabolism. Men with prediabetes were randomized to eTRF (6-hr feeding period, with dinner before 3 p.m.) or a control schedule (12-hr feeding period) for 5 weeks and later crossed over to the other schedule. The study found that eTRF improved insulin sensitivity, β cell responsiveness, blood pressure, oxidative stress, and appetite.

Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study – Diabetes Therapy

Carbohydrate restriction markedly improves glycemic control in patients with type 2 diabetes (T2D) but necessitates prompt medication changes. This study examined the effectiveness and safety of a novel care model providing continuous remote care with medication management based on biometric feedback combined with the metabolic approach of nutritional ketosis for T2D management. It found that the novel care model supports adults with T2D to safely improve HbA1c, weight, and other biomarkers while reducing diabetes medication use.

Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial – Frontiers in Endocrinology

This study found that patients involved in digitally-monitored continuous care intervention (CCI) including nutritional ketosis sustained long-term beneficial effects on multiple clinical markers of diabetes and cardiometabolic health at 2 years while utilizing less medication. The CCI intervention was also effective in the resolution of diabetes and visceral obesity with no adverse effect on bone health.

Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study – Cardiovascular Diabetology

This study investigated cardiovascular disease risk factors in patients with T2D who participated in a 1 year open label, non-randomized, controlled trial.  A continuous care treatment including nutritional ketosis in patients with T2D improved most biomarkers of CVD risk after 1 year. The increase in LDL-cholesterol appeared limited to the large LDL subfraction. LDL particle size increased, total LDL-P and ApoB were unchanged, and inflammation and blood pressure decreased.

Metabolic Effects of Intermittent Fasting – Annual Review of Nutrition

This paper included an overview of intermittent fasting regimens, summary of the evidence on the health benefits of intermittent fasting, and discussion of physiological mechanisms by which intermittent fasting might lead to improved health outcomes.