Date of Award

Spring 2020

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Erin Wolf

Abstract

Introduction: In recent decades, the number of people affected by type 2 diabetes mellitus has been a topic of interest. The wide reaching impact on both, individual and societal, healthcare costs and quality measures, begs for attention and interventions. Lifestyle modifications, such as: weight management or loss, increasing physical activity, and making healthier dietary choices, are the first line intervention. However, there are not studies that directly compare the role of a single dietary approach to a form of physical activity. Rather, different diets go head to head as well as aerobic versus resistance training. Therefore, in an attempt to provide practitioners with a solitary intervention to advocate to their patients, the purpose of this paper is going to assess: In adults (18-75 years old) with a BMI >25 and type 2 diabetes, how does a low-carbohydrate ketogenic diet compare to aerobic physical activity in the management of glucose control indices and treatment of type 2 diabetes?

Methods: Database searches were generated through PubMed, ClinicalKey, and GoogleScholar yielding seven studies for this review. Inclusion criteria consisted of: adults 18-75 years old, with a BMI >25 and type 2 diabetes, and outcome measures that focused on components of the management and treatment of type 2 diabetes, such as glycemic control, weight management, or quality of life.

Results: When comparing aerobic physical activity and a low carbohydrate ketogenic diet head to head, the evidence demonstrates statistically significant greater improvements in hemoglobin A1c, anthropology, and medication use with a low carbohydrate ketogenic diet. All of the studies, with parameters of <50g of carbohydrates per day, had significant changes in hemoglobin A1c, which could guide future recommendations. The statistical significance of these results also translates into clinically significant improvements in the care associated with type 2 diabetes.

Discussion: Optimal management of type 2 diabetes mellitus is a multifactorial approach to physical activity, weight management, and good dietary habits. While this review favored a low carbohydrate ketogenic diet, it is hard to determine the sustainability of a low carbohydrate ketogenic diet past several months based on these studies. Furthermore, there were not as many studies available to conclusively say dietary changes are superior to aerobic physical activity.

Conclusion: In an effort to have patients to change behavioral habits, focusing on one lifestyle modification may be the key initial step to encourage further changes. This literature review reveals that encouraging a low carbohydrate ketogenic diet should be a primary focus for healthcare providers.

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Low carbohydrate ketogenic diet versus aerobic physical activity in the management and treatment of type 2 diabetes: A review paper

Introduction: In recent decades, the number of people affected by type 2 diabetes mellitus has been a topic of interest. The wide reaching impact on both, individual and societal, healthcare costs and quality measures, begs for attention and interventions. Lifestyle modifications, such as: weight management or loss, increasing physical activity, and making healthier dietary choices, are the first line intervention. However, there are not studies that directly compare the role of a single dietary approach to a form of physical activity. Rather, different diets go head to head as well as aerobic versus resistance training. Therefore, in an attempt to provide practitioners with a solitary intervention to advocate to their patients, the purpose of this paper is going to assess: In adults (18-75 years old) with a BMI >25 and type 2 diabetes, how does a low-carbohydrate ketogenic diet compare to aerobic physical activity in the management of glucose control indices and treatment of type 2 diabetes?

Methods: Database searches were generated through PubMed, ClinicalKey, and GoogleScholar yielding seven studies for this review. Inclusion criteria consisted of: adults 18-75 years old, with a BMI >25 and type 2 diabetes, and outcome measures that focused on components of the management and treatment of type 2 diabetes, such as glycemic control, weight management, or quality of life.

Results: When comparing aerobic physical activity and a low carbohydrate ketogenic diet head to head, the evidence demonstrates statistically significant greater improvements in hemoglobin A1c, anthropology, and medication use with a low carbohydrate ketogenic diet. All of the studies, with parameters of <50g of carbohydrates per>day, had significant changes in hemoglobin A1c, which could guide future recommendations. The statistical significance of these results also translates into clinically significant improvements in the care associated with type 2 diabetes.

Discussion: Optimal management of type 2 diabetes mellitus is a multifactorial approach to physical activity, weight management, and good dietary habits. While this review favored a low carbohydrate ketogenic diet, it is hard to determine the sustainability of a low carbohydrate ketogenic diet past several months based on these studies. Furthermore, there were not as many studies available to conclusively say dietary changes are superior to aerobic physical activity.

Conclusion: In an effort to have patients to change behavioral habits, focusing on one lifestyle modification may be the key initial step to encourage further changes. This literature review reveals that encouraging a low carbohydrate ketogenic diet should be a primary focus for healthcare providers.