J Endocr Soc
Keto diet tied to better beta cell function in early diabetes
Clinical takeaway: Along with plant-based diets, keto diets may be a useful option to try for early type 2 diabetes patients.
Beta cell dysfunction drives progression of type 2 diabetes, but few interventions have been shown to improve it directly. Prior work has suggested carbohydrate restriction may reduce insulin demand and pancreatic stress. This study tested whether a ketogenic diet would improve a biomarker of beta cell stress.
Investigators conducted a 12-week randomized trial involving 51 adults with early type 2 diabetes comparing a ketogenic diet with a low-fat diet. The primary measure in this secondary analysis was the proinsulin-to-C-peptide ratio, a marker of beta cell stress, with beta cell function assessed by hyperglycemic clamp.
Patients assigned to the ketogenic diet had a 56% greater reduction in fasting proinsulin-to-C-peptide ratio and a 49% greater reduction in post-challenge ratio than those assigned to the low-fat diet. Greater reductions in the ratio were associated with improved acute and maximal C-peptide responses, linking the biomarker change to better beta cell function.
The findings suggest a ketogenic diet may reduce pancreatic beta cell stress in early type 2 diabetes even when major weight loss is not the main mechanism. Whether these physiologic changes translate into more durable glycemic control or remission remains unclear.
“We showed that three months of a ketogenic diet was able to improve beta-cell function in patients with type 2 diabetes, and these improvements were associated with changes in the proinsulin-C-peptide ratio, a biomarker of pancreas stress,” said lead study author Marian Yurchishin of the University of Alabama at Birmingham. “Other than bariatric surgery or large-volume intentional weight loss, interventions for improving beta-cell function in type 2 diabetes do not currently exist.”
Source: Yurchishin M. J Endocr Soc. 2026 Apr 21. Greater reduction in the proinsulin-C-peptide ratio with a ketogenic vs control diet in patients with type 2 diabetes