Research Summary

Analyzed using Evidence Intelligence™

Online ketogenic diet improves glycemic control in type 2 diabetes

Last updated September 12, 2026

Key finding

Participants in the intervention group reduced their HbA1c levels more (estimated marginal mean [EMM] -0.8%, 95% CI -1.1% to -0.6%) than participants in the control group (EMM -0.3%, 95% CI -0.6% to 0.0%; P =.002).

This pilot study evaluated the feasibility of an online very low-carbohydrate ketogenic diet for individuals with type 2 diabetes, showing significant improvements in key health metrics.

Quick read

Study at a glance

The essential study design details in one scan.

EvidenceScore™

Moderate

Study type

RCTs

Follow-up

Medium-Term (3–12 mo)

Risk of bias

Some Concerns

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Plain-language summary

What this paper says

A plain-language read of the study’s main message and where it applies.

Study focus

This pilot study evaluated the feasibility of an online very low-carbohydrate ketogenic diet for individuals with type 2 diabetes, showing significant improvements in key health metrics.

Clinical relevance

These findings suggest that a very low-carbohydrate ketogenic diet may be a viable option for individuals with type 2 diabetes seeking to improve their blood sugar levels and lose weight. Given the increasing prevalence of diabetes, effective dietary strategies are crucial for managing this condition and reducing associated health risks.

Keep in mind

Small sample size limits generalizability. Short duration may not capture long-term effects. Lack of diverse population may affect applicability.

Published in

Journal Reference

Publication details and source links for this paper.

Gunther E, Michelle J, Yasmine P, et al. Online Very Low-Carbohydrate Ketogenic Diet Intervention for Type 2 Diabetes: A Pilot Feasibility Study. Journal of Medical Internet Research. 2017;19(2):e36. doi:10.2196/jmir.5806

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Main Effects

Intervention group reduced HbA1c by -0.8% compared to -0.3% in control (p=0.002).

Weight loss in the intervention group was -12.7 kg versus -3.0 kg in control (p<0.001).

Triglyceride levels decreased by -60.1 mg/dL in the intervention group compared to -6.2 mg/dL in control (p=0.01).

Evidence network

How this study fits

Understand where this research contributes within the broader evidence network.

Evidence Context

This study contributes evidence to Low-carbohydrate diet and Dropout rate, HbA1c, Proportion of participants achieving HbA1c < 6.5%, and 2 more.

This study contributes evidence to

Intervention

Low-carbohydrate diet

Outcome

Dropout rate

Evidence topic

Dietary Patterns

Primary intervention

Low-carbohydrate diet

Primary outcomes

Dropout rate
HbA1c
Proportion of participants achieving HbA1c < 6.5%

Evidence topics

Dietary Patterns HbA1c Reduction Weight Loss

Primary intervention

Low-carbohydrate diet

Primary outcomes

Dropout rate HbA1c Proportion of participants achieving HbA1c < 6.5%

Evidence relationships

Intervention and outcome relationships this study adds to the evidence network.

Evidence pairs

Relationships

Evidence topics

contributes_evidence

Editorial context

Why this study matters

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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.

Moderate contributionModerate confidenceNetwork score: 68

Why it is useful

Contributes to 5 evidence relationships
Includes primary outcome data
Linked to 3 direct semantic evidence topics

Topic contributions

Evidence topic

Contributes evidence

Evidence topic

Contributes evidence

Evidence topic

Contributes evidence

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Primary evidence

Evidence relationship

Low-Carbohydrate Diet Education and Body Weight

Related evidence

Evidence relationship

Low-Carbohydrate Diet Education and HbA1c

Save evidence

Evidence relationship

Low-Carbohydrate Diet Education and Adipokine and Angiogenic Markers

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Core evidence

Study findings

The primary outcomes reported in this study.

Dropout rate

Low-carbohydrate diet → Dropout rate

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 50; Neutral
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

HbA1c

Low-carbohydrate diet → HbA1c

Evidence Intelligence™

EvidenceScore™: 86; Strong
ImpactScore™: 82; Positive
ConsistencyScore™: 65; generally_consistent

Based on 24 studies

Add to Evidence Tracker

Proportion of participants achieving HbA1c < 6.5%

Low-carbohydrate diet → Proportion of participants achieving HbA1c < 6.5%

Evidence Intelligence™

EvidenceScore™: Emerging; Score 59 · Based on 1 study
ImpactScore™: 100; Very Positive
ConsistencyScore™: unclear; Not enough independent studies

Based on 1 study

Add to Evidence Tracker

Triglycerides

Low-carbohydrate diet → Triglycerides

Evidence Intelligence™

EvidenceScore™: 67; Moderate
ImpactScore™: 92; Very Positive
ConsistencyScore™: 67; generally_consistent

Based on 3 studies

Add to Evidence Tracker

Weight change

Low-carbohydrate diet → Weight change

Evidence Intelligence™

EvidenceScore™: Moderate; Score 69 · Based on 2 studies
ImpactScore™: 100; Very Positive
ConsistencyScore™: 100; consistent

Based on 2 studies

Add to Evidence Tracker

Evidence Library

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Evidence Suggest

55% of ketogenic diet participants achieved HbA1c < 6.5% vs 0% in control (p=0.02).
Dropout rates were 8% in intervention vs 46% in control (p=0.07).

Who this applies to

Adults diagnosed with type 2 diabetes.
Individuals seeking dietary interventions for diabetes management.

Keep in Mind

Results may not apply to broader populations due to sample size.
Further research needed to confirm long-term effects.
Diet adherence and participant engagement were not fully assessed.

Between the Lines

Small sample size limits generalizability.
Short duration may not capture long-term effects.
Lack of diverse population may affect applicability.

Evidence Library

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Connected Evidence

Explore related studies, evidence collections, and research questions.

Relationships organized using the Dediabetes Evidence Intelligence™ framework.

This study contributes to evidence on Low-Carbohydrate Diet Education and HbA1c, Low-Carbohydrate Diet Education and Body Weight.

Related evidence relationships

Explore in Evidence Explorer

This study contributes to the evidence on the following intervention-outcome relationships.

Diet and Nutrition

Detailed evidence

Low-Carbohydrate Diet Education → HbA1c

Diet and Nutrition

Evidence Intelligence™

EvidenceScore™: 86; Strong
ImpactScore™: 82; Positive
ConsistencyScore™: 65; generally_consistent

Based on 24 studies

View evidence

Diet and Nutrition

Detailed evidence

Low-Carbohydrate Diet Education → Body Weight

Diet and Nutrition

Evidence Intelligence™

EvidenceScore™: Moderate; Score 69 · Based on 2 studies
ImpactScore™: 100; Very Positive
ConsistencyScore™: 100; consistent

Based on 2 studies

View evidence

Included in these evidence collections

Curated evidence collections and hubs this study is part of.

HbA1c Evidence Hub

All studies measuring HbA1c

24 studies

outcome_hub

Measures HbA1c as a key outcome.

Low-Carbohydrate Diet Education Evidence Hub

All studies on Low-Carbohydrate Diet Education

24 studies

intervention_hub

Contributes to Low-Carbohydrate Diet Education evidence base.

Body Weight Evidence Hub

All studies measuring Body Weight

2 studies

outcome_hub

Measures Body Weight as a key outcome.

Explore more in Evidence Explorer

Jump to pre-filtered views in Evidence Explorer.

All studies on Low-carbohydrate diet and HbA1c

Intervention: Low-carbohydrate dietOutcome: HbA1c

24 results

All studies on Low-carbohydrate diet and Weight change

Intervention: Low-carbohydrate dietOutcome: Weight change

2 results

All studies on Low-carbohydrate diet

Intervention: Low-carbohydrate diet

24 results

All studies measuring HbA1c

Outcome: HbA1c

24 results

All studies measuring Weight change

Outcome: Weight change

2 results

Questions answered by this study

Generated from the study's connected evidence using Evidence Intelligence™.

Does Low-Carbohydrate Diet Education affect body weight?

Strong Evidence

Low-Carbohydrate Diet Education appears to affect body weight.

ConsistencyScore™: Results are consistent across studies.

Ranked evidence signals

1
Weight change
EvidenceScore™ Moderate | EvidenceScore™ 69.0 | strong positive | ConsistencyScore™ Consistent | 1 study

Why this answer: This answer is based on 17 supporting studies with consistent results and a positive effect signal.

View Full Evidence

Does Low-Carbohydrate Diet Education lower HbA1c?

Strong Evidence

Low-Carbohydrate Diet Education may lower HbA1c.

ConsistencyScore™: Results are generally consistent across studies.

Ranked evidence signals

1
HbA1c
EvidenceScore™ Strong | EvidenceScore™ 86.0 | moderate positive | ConsistencyScore™ Generally Consistent | 1 study

Why this answer: This answer is based on 28 supporting studies with generally consistent results and a positive effect signal.

View Full Evidence

Does Low-Carbohydrate Diet Education improve adipokine and angiogenic markers?

Strong Evidence

Low-Carbohydrate Diet Education appears to improve adipokine and angiogenic markers.

ConsistencyScore™: Results are consistent across studies.

Ranked evidence signals

1
Triglycerides
EvidenceScore™ Moderate | EvidenceScore™ 67.0 | strong positive | ConsistencyScore™ Generally Consistent | 1 study

Why this answer: This answer is based on 5 supporting studies with consistent results and a positive effect signal.

View Full Evidence

Does Low-carbohydrate diet improve proportion of participants achieving HbA1c < 6.5%?

Emerging Evidence

Low-carbohydrate diet appears to improve proportion of participants achieving HbA1c < 6.5%.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

1
Proportion of participants achieving HbA1c < 6.5%
EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

Only one supporting study is available.

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Next steps

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Evidence topics

Follow the topics this study contributes to.

Dietary Patterns Evidence Hub HbA1c Reduction Evidence Hub Weight Loss Evidence Hub

Explore in Evidence Explorer

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All studies on Low-carbohydrate diet and HbA1c All studies on Low-carbohydrate diet and Weight change All studies on Low-carbohydrate diet and Triglycerides All studies on Low-carbohydrate diet and Dropout rate

Related research

Read related research summaries.

Carbohydrate restriction lowers HbA1c but not β-cell function in T2D Food-based diet improves weight and glycaemic control in type 2 diabetes Moderate Carbohydrate Diet Improves Glycemic Control in Type 1 Diabetes Ketogenic diet improves weight and blood glucose control in type 2 diabetes Low-Carbohydrate Diet Improves Glycemic Control in Adolescents with Type 1 Diabetes

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