Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets
Authors' conclusion
Very low carbohydrate ketogenic diets are generally safe with low rates of IAK, including DKA, in people with and without type 2 diabetes. The higher incidence of DKA in PWD on VLCKD who are also on SGLT2-inhibitors may be manageable through at-home monitoring of BHB levels.
Study context
- Population
- Patients of a single-centre telemedicine clinic using a very low carbohydrate ketogenic diet (VLCKD) as lifestyle intervention, with and without T2D72,751 patient-years
- Exposure
- People without diabetes vs people with T2D on a VLCKD
- Outcome
- Incidence of illnesses associated with ketosis (IAK; Beta-hydroxybutyrate (BHB) ≥3 mmol/L when seeking in-person care) and DKA
Methodological detailssingle-centre, real world data, telemedicine clinic
- Single-centre
- Real world data
- Telemedicine clinic
Main finding
As reported in the abstract
- Illnesses associated with ketosis (IAK) overall (86 people)
- 1.18 per 1000 person-years
- IAK, without diabetes (22 347 patient-years)
- 0.04 per 1000 person-years
- Diabetic ketoacidosis (DKA), without diabetes
- 0
- IAK, PWD (50 404 patient-years)
- 1.69 per 1000 person-years
- DKA, PWD
- 1.01 per 1000 person-years
Observational data: associations, not effects.
Further findings
DKA in PWD using SGLT2i
- DKA incidence, PWD on SGLT2i (12 763 person-years)
- 2.90 per 1000 patient-years
Original publication
Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets. Diabetes Obes Metab. Published 25 February 2025. doi:10.
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