Effect of Ketogenic Diet on Glucose Metabolism and Energy Expenditure in Type 2 Diabetes
Study Details
Study Description
Brief Summary
The study team will examine the effect of a ketogenic diet alone and ketogenic diet supplemented with oral ketones on how the body of individuals with type 2 diabetes respond to insulin, regulates insulin secretion, food intake and energetic pathways and influences body fat distribution.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Subjects will be randomized into three groups (1) standard, weight maintaining diet containing approximately 25-35% protein, 45-55% carbohydrate, 20-30% fat; (2) weight maintaining isocaloric ketogenic diet containing approximately 15-25% protein, 5-10% carbohydrate, 70-80% fat; (3) weight maintaining isocaloric diet containing approximately 15-25% protein, 5-10% carbohydrate, 70-80% fat supplemented with the ketone ester of beta-hydroxy butyrate, 8 grams every 8 hours to further increase the plasma ketone concentration by ~3 mM. Subjects will be further randomized on the basis of:
(i) HbA1c 7.0-8.5% and 8.5-10.5% to ensure similar baseline levels of glucose control and (ii) drug naïve versus drug-treated. At the time of screening, after a 10-12 hour overnight fast, indirect calorimetry will be performed with a ventilated hood system for 60 minutes to measure baseline energy expenditure. An initial weight maintenance energy requirement estimate as 1.5 times resting energy expenditure (obtained by indirect calorimetry) will be started. Diets will consist of a 10-day rotating menu using NutriAdmin for meal planning and Nutrition Maker for analysis of recipes Food will be prepared in the Cafeteria and or the Metabolic Kitchen at the Texas Diabetes Institute and certified by a dietician. Subjects will report to the diet kitchen at 8 AM on Monday through Saturday where they will eat their breakfast and pick up food for their lunch and dinner. On Saturday, participants also will be given food for their Sunday meals. Subjects will maintain a daily dietary log with all food consumed. On each visit subjects will be weighed; dietary log will be reviewed and the caloric content of the diet will be adjusted to maintain the body weight constant. Blood pressure will be measured in the reclining position x 2 separate days. Antidiabetic medications will not be changed during the study unless hypoglycemia (fasting plasma glucose <70 mg/dl or symptoms) occurs. The study duration will be 10 days which should be sufficient to observe the effect of hyperketonemia on glucose/lipid metabolism and energy expenditure. If participant cannot come on the last days of his/her diet treatment, than we will extend this period up to 13 days and participant will be given diet for additional days till completion of the study visits.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Standard Weight Maintenance Standard weight maintenance diet will be provided for 10 days for subjects who are not currently treated with a T2DM medication. |
Other: Standard weight maintaining diet
Diet containing diet approximately 25-35% protein, 45-55% carbohydrate, 20- 30% fat
|
| Active Comparator: Isocaloric Diet Isocaloric diet will be provided for 10 days for subjects who are currently treated with a T2DM medication included in the inclusion criteria |
Other: Weight maintaining isocaloric ketogenic diet
Isocaloric ketogenic diet containing approximately 15-25% protein, 5-10% carbohydrate,70- 80% fat
|
| Active Comparator: Isocaloric Diet with Beta-hydroxy butyrate Isocaloric diet with Beta-hydroxy butyrate will be provided for 10 days for subjects who are not currently treated with a T2DM medication. |
Other: Weight maintaining isocaloric ketogenic diet
Isocaloric ketogenic diet containing approximately 15-25% protein, 5-10% carbohydrate,70- 80% fat
Dietary Supplement: Beta-hydroxy butyrate
A supplement of ketone ester of beta-hydroxy butyrate
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Fasting plasma glucose (FPG) [Baseline to 10 days]
A change in FPG will be measured
- Hepatic Glucose production (HGP) [Baseline to 10 days]
Change of hepatic glucose production will be measured using 3H-glucose infusion
- Whole Body Fat Oxidation [Baseline to 10 days]
Change in whole body fat oxidation will be measured using indirect calorimetry
- Total Body Fat [Baseline to 10 days]
Change in whole body fat
- Hepatic Fat Content [Baseline to 10 days]
Change in hepatic fat content
Secondary Outcome Measures
- Plasma Insulin [Baseline to 10 days]
Change in plasma insulin will be measured
- C-peptide [Baseline to 10 days]
Change in C-peptide will be measured
- Free Fatty Acid (FFA) [Baseline to 10 days]
Change in FFA will be measured
- Glycerol level [Baseline to 10 days]
Change in Glycerol level will be measured
- Low density lipoproteins (LDL) [Baseline to 10 days]
Change in LDL
- High density lipoproteins (HDL) [Baseline to 10 days]
Change in HDL
- Triglycerides [Baseline to 10 days]
Change in triglyceride levels
- Urine Microalbumin excretion [Baseline to 10 days]
Change in urine microalbumin excretion
- Glycated hemoglobin test (HbA1c) [Baseline to 10 days]
Change in HbA1c
- Fructosamine level [Baseline to 10 days]
Change in fructosamine
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Age from 18-70 years
-
BMI = 27.5-42 kg.m2
-
HbA1c = 7.0-10.5
-
Weight stable (±4-5lb) in the preceding 3 months
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Good general health
Exclusion Criteria:
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Use of medications that affect glucose tolerance other than metformin/sulfonylurea/DPP4 Inhibitor
-
Major organ disease
-
Estimated Glomerular filtration rate (eGFR) <60 ml/min
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Type 1 diabetes
-
Hematocrit < 34 (if HbA1c is in the 8.5 to 10% range)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University Health Systems-Texas Diabetes Institute | San Antonio | Texas | United States | 78207 |
| 2 | University of Texas Health Science Center at San Antonio | San Antonio | Texas | United States | 78229 |
Sponsors and Collaborators
- The University of Texas Health Science Center at San Antonio
Investigators
- Principal Investigator: Ralph DeFronzo, MD, University of Texas Health at San Antonio
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HSC20200230H