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      Does a Ketogenic Diet Have a Place Within Diabetes Clinical Practice? Review of Current Evidence and Controversies

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          Abstract

          Carbohydrate restriction has gained increasing popularity as an adjunctive nutritional therapy for diabetes management. However, controversy remains regarding the long-term suitability, safety, efficacy and potential superiority of a very low carbohydrate, ketogenic diet compared to current recommended nutritional approaches for diabetes management. Recommendations with respect to a ketogenic diet in clinical practice are often hindered by the lack of established definition, which prevents its capacity to be most appropriately prescribed as a therapeutic option for diabetes. Furthermore, with conflicted evidence, this has led to uncertainty amongst clinicians on how best to support and advise their patients. This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies.

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          Epidemiology of Type 2 Diabetes – Global Burden of Disease and Forecasted Trends

          The rising burden of type 2 diabetes is a major concern in healthcare worldwide. This research aimed to analyze the global epidemiology of type 2 diabetes. We analyzed the incidence, prevalence, and burden of suffering of diabetes mellitus based on epidemiological data from the Global Burden of Disease (GBD) current dataset from the Institute of Health Metrics, Seattle. Global and regional trends from 1990 to 2017 of type 2 diabetes for all ages were compiled. Forecast estimates were obtained using the SPSS Time Series Modeler. In 2017, approximately 462 million individuals were affected by type 2 diabetes corresponding to 6.28% of the world’s population (4.4% of those aged 15–49 years, 15% of those aged 50–69, and 22% of those aged 70+), or a prevalence rate of 6059 cases per 100,000. Over 1 million deaths per year can be attributed to diabetes alone, making it the ninth leading cause of mortality. The burden of diabetes mellitus is rising globally, and at a much faster rate in developed regions, such as Western Europe. The gender distribution is equal, and the incidence peaks at around 55 years of age. Global prevalence of type 2 diabetes is projected to increase to 7079 individuals per 100,000 by 2030, reflecting a continued rise across all regions of the world. There are concerning trends of rising prevalence in lower-income countries. Urgent public health and clinical preventive measures are warranted.
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            Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

            Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes.
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              Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association

              The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
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                Author and article information

                Contributors
                a.c.brown@ucl.ac.uk
                Journal
                Diabetes Ther
                Diabetes Ther
                Diabetes Therapy
                Springer Healthcare (Cheshire )
                1869-6953
                1869-6961
                15 November 2023
                15 November 2023
                January 2024
                : 15
                : 1
                : 77-97
                Affiliations
                [1 ]Centre for Obesity Research, University College London, ( https://ror.org/02jx3x895) London, UK
                [2 ]GRID grid.451056.3, ISNI 0000 0001 2116 3923, National Institute of Health Research, ; London, UK
                [3 ]GRID grid.439749.4, ISNI 0000 0004 0612 2754, Bariatric Centre for Weight Management and Metabolic Surgery, , University College London Hospital NHS Trust, ; London, UK
                [4 ]Aston Medical School, Aston University, ( https://ror.org/05j0ve876) Birmingham, UK
                [5 ]Centre for Health and Society, Aston University, ( https://ror.org/05j0ve876) Birmingham, UK
                [6 ]GRID grid.255434.1, ISNI 0000 0000 8794 7109, Edge Hill Medical School, , Edge Hill, ; Ormskirk, UK
                [7 ]Norwood Avenue Surgery, Southport, UK
                [8 ]NNEdPro Global Institute for Food, Nutrition and Health, Cambridge, UK
                Author information
                http://orcid.org/0000-0003-1818-6192
                Article
                1492
                10.1007/s13300-023-01492-4
                10786817
                37966583
                c7ec1068-6e50-4bfb-8c73-63960743cf76
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 17 August 2023
                : 10 October 2023
                Categories
                Review
                Custom metadata
                © Springer Healthcare Ltd., part of Springer Nature 2024

                Endocrinology & Diabetes
                ketogenic diets,low carbohydrate diets,type 2 diabetes,type 1 diabetes,obesity

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