Last updated September 12, 2026
Key finding
Diet assignment was a significant predictor of change in fasting PICP (PICP 0) (KD vs LFD β = −0.18 [−11.16, −0.05])
This study compared the effects of a ketogenic diet and a low-fat diet on proinsulin levels in individuals with type 2 diabetes, finding that the ketogenic diet led to a greater reduction in proinsulin levels.
Quick read
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EvidenceScore™
Moderate
Study type
RCTs
Follow-up
Medium-Term (3–12 mo)
Risk of bias
Some Concerns
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Plain-language summary
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Study focus
This study compared the effects of a ketogenic diet and a low-fat diet on proinsulin levels in individuals with type 2 diabetes, finding that the ketogenic diet led to a greater reduction in proinsulin levels.
These findings are significant for clinical practice as they suggest that dietary interventions, specifically a ketogenic diet, can lead to improved metabolic markers in individuals with type 2 diabetes. Reducing proinsulin levels may help in better managing diabetes and reducing the risk of complications associated with the disease.
The study's sample size and demographic diversity were not specified. Long-term effects of the diets were not assessed beyond the 12-week period. Potential confounding factors were not fully explored.
Published in
Publication details and source links for this paper.
Marian LY, Amanda RF, Lauren AF, Sara LV, Barbara AG. A Ketogenic Diet Reduces Proinsulin Levels More Than a Low-Fat Diet in Type 2 Diabetes. Journal of the Endocrine Society. 2026;10(5):bvag073. doi:10.1210/jendso/bvag073
The ketogenic diet reduced fasting proinsulin to C-peptide ratio (PICP 0) by β = -0.18 (p = 0.048).
The ketogenic diet reduced 190-minute proinsulin to C-peptide ratio (PICP 190) by β = -0.23 (p = 0.007).
Changes in acute C-peptide response were inversely associated with changes in both PICP 0 and PICP 190.
Evidence network
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This study contributes evidence to Low-carbohydrate diet, Low-fat diet and 190-minute proinsulin to C-peptide ratio (PICP 190), Fasting blood sugar (FBS), acute C-peptide response (ACP).
This study contributes evidence to
Primary intervention
Low-carbohydrate diet
Primary outcomes
Evidence topics
Primary intervention
Intervention and outcome relationships this study adds to the evidence network.
Editorial context
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Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
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Evidence pairs
886
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Contributes evidence
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Contributes evidence
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Core evidence
The primary outcomes reported in this study.
Low-carbohydrate diet → 190-minute proinsulin to C-peptide ratio (PICP 190)
Low-carbohydrate diet → 190-minute proinsulin to C-peptide ratio (PICP 190)
Low-carbohydrate diet → acute C-peptide response (ACP)
Low-carbohydrate diet → acute C-peptide response (ACP)
Low-carbohydrate diet → Fasting blood sugar (FBS)
Low-carbohydrate diet → Fasting blood sugar (FBS)
Low-fat diet → 190-minute proinsulin to C-peptide ratio (PICP 190)
Low-fat diet → 190-minute proinsulin to C-peptide ratio (PICP 190)
Low-fat diet → acute C-peptide response (ACP)
Low-fat diet → acute C-peptide response (ACP)
Low-fat diet → Fasting blood sugar (FBS)
Low-fat diet → Fasting blood sugar (FBS)
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Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on Low-Carbohydrate Diet Education and Fasting Glucose, Low-Carbohydrate Diet Education and 190-minute proinsulin to C-peptide ratio (PICP 190).
This study contributes to the evidence on the following intervention-outcome relationships.
Diet and Nutrition
Diet and Nutrition
Curated evidence collections and hubs this study is part of.
All studies measuring Fasting Glucose
Measures Fasting Glucose as a key outcome.
All studies on Low-Carbohydrate Diet Education
Contributes to Low-Carbohydrate Diet Education evidence base.
All studies measuring 190-minute proinsulin to C-peptide ratio (PICP 190)
Measures 190-minute proinsulin to C-peptide ratio (PICP 190) as a key outcome.
Latest published studies
Published within the last 2 years.
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2 results
1 results
2 results
2 results
1 results
Generated from the study's connected evidence using Evidence Intelligence™.
Low-Carbohydrate Diet Education appears to improve fasting glucose.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Fasting blood sugar (FBS)
EvidenceScore™ Moderate | EvidenceScore™ 69.0 | strong positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on 13 supporting studies with consistent results and a positive effect signal.
Low-fat Diets appear to improve fasting glucose.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
Fasting blood sugar (FBS)
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a small number of supporting studies and should be interpreted cautiously.
Limitations
Low-carbohydrate diet appears to improve 190-minute proinsulin to c-peptide ratio (picp 190).
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
190-minute proinsulin to C-peptide ratio (PICP 190)
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
Low-fat diet appears to improve 190-minute proinsulin to c-peptide ratio (picp 190).
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
190-minute proinsulin to C-peptide ratio (PICP 190)
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
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