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Global Translational Medicine Keto diet in management of Type 2 diabetes

public health hazard, potentially impairing individual Low-carbohydrate diets have immensely improved
work efficiency . T2DM, glycemic disorders, and obesity . However, the
[3]
[11]
Since 1970, the global incidence of obesity has tripled, evidence supporting the efficacy of low-carbohydrate
marking a substantial increase in prevalence and severity. dietary approaches in treating T2DM and obesity over
[12]
Obesity has emerged as a primary underlying factor the long-term remains insufficient . It is noteworthy
contributing to long-term disorders, including metabolic that the ketogenic diet (KD) gained prominence as the
syndromes, vascular malformations, chronic renal disorders, principal therapeutic option for managing diabetes before
th
[12]
malignancies, and Type 2 diabetes mellitus (T2DM), leading the introduction of insulin in the early 20 century .
to a persistent rise in both mortality and morbidity rates . In 1921, Russell Wilder pioneered the use of KD to treat
[4]
Diabetes, recognized as a predominant cause of mortality epilepsy. An increase in the use of KD for rapid weight
and morbidity, particularly through the progression of loss represents a relatively recent development. This
cardiovascular disease, is a pressing concern in the United approach has demonstrated significant effectiveness within
States . The number of individuals diagnosed with diabetes a short period of time, involving adherence to specific
[5]
exceeds 30 million, with an annual escalation in the recommended and restricted foods (Table 1). Effective
population of overweight or obese individuals. Projections implementation of KD has been associated with weight
suggest that approximately 30 – 40% of the country’s total loss, improved insulin sensitivity, and a reduction in
[13]
population may fall into the category of overweight or obese hyperinsulinemia .
by the year 2030, indicating a persistently high prevalence of Dr. Elliot Joslin’s diabetic diet primarily comprised
[6]
these conditions in the United States . fat (75%), protein (20%), and carbohydrates (<5%) [1,14] .
An important global public health concern revolves Similarly, Dr. Allen, a medical expert, advocated for a low-
[14]
around the economic burden of T2DM , a burden that carbohydrate diet for the treatment of T2DM .
[7]
exhibits variability across dimensions such as age, education, While the necessity for appropriate dietary habits has
income, geography, race/ethnicity, and other social diminished with the utilization of insulin as a restorative
determinants of health. Individuals with lower levels of practice for diabetes, obesity remains intricately linked
education and household income distinctly shoulder a greater to the development of hyperglycemia, diabetes, and
burden than their counterparts with higher socioeconomic other related metabolic disorders. Individuals who are
status, and these disparities have widened over time . overweight or obese exhibit a heightened susceptibility to
[8]
The International Diabetes Federation estimates that by various diseases. Conditions such as diabetes mellitus, high
2040, the global diabetic population will reach 642 million, cholesterol, elevated lipid levels, and disorders in energy
[15]
reflecting an annual escalation in disease frequency. metabolism are prevalent among this demographic .
T2DM entails both direct and indirect economic costs, Addressing obesity not only mitigates these risks but also
with the former comprising a substantial portion of the significantly reduces the likelihood of other global health
overall economic burden. This includes direct medical crises, including diabetes, cardiovascular diseases, and
resource consumption, encompassing inpatient and other non-communicable diseases.
outpatient costs, prescription expenses, diagnostic tests, Improving insulin sensitivity in T2DM is often
and emergency department charges . In addition to accompanied by carbohydrate intolerance. Carbohydrate
[7]
the direct (healthcare-related) costs, T2DM imposes deprivation (as observed in KD) can significantly enhance
significant indirect costs, notably work productivity losses blood glucose control, while weight loss can positively
due to factors such as absenteeism or impaired working impact insulin resistance (IR). The potential of KD as a
ability in the workplace attributable to illness. In addition, treatment for conditions such as obesity and T2DM has
untimely retirement and premature deaths resulting from generated considerable interest. However, the available
the disease contribute to this economic impact of reduced information on its efficacy remains insufficient and the
productivity. Importantly, these consequences extend associated risks to individual diets are noteworthy .
[16]
beyond the individual, affecting family, society, and the The correlation between obesity and diabetes has
country at large. The ramifications include implications for been extensively explored in numerous research. This
income, taxes, and a decline in gross domestic product . article specifically focuses on elucidating the various
[9]
Considering this issue, world leaders have committed mechanisms through which the low-carbohydrate diet can
to reducing the burden of non-communicable illnesses, mitigate obesity and reduce the risk of T2DM. The aim
including diabetes, by one-third through universal health of this narrative review is to formulate a comprehensive
coverage and affordable essential medicines to achieve the understanding of the role of KDs in addressing the
sustainable development goal targets for 2030 . challenges of obesity and T2DM.
[10]

Volume 2 Issue 4 (2023) 2 https://doi.org/10.36922/gtm.1361