Category Archives: prediabetes

Keto Versus Mediterranean Diet: Which Is Best for T2 Diabetics and Prediabetics

professor, equations

Effect of a Ketogenic Diet versus Mediterranean Diet on HbA1c in Individuals with Prediabetes and Type 2 Diabetes Mellitus: the Interventional Keto-Med Randomized Crossover Trial

Right off the bat, I don’t like that they studied both diabetics and prediabetics. There were only 40 original study participants, with complete data on only 33. Why lump the two together?

Participants followed each diet for 12 weeks then lab data and body weight were assessed.

The researchers conclusions:

HbA1c [a measure of blood sugar control] was not different between diet phases after 12-weeks, but improved from baseline on both diets, likely due to several shared dietary aspects. WFKD [ketogenic diet] was beneficial for greater decrease in triglycerides, but also had potential untoward risks from elevated LDL-C, and lower nutrient intakes from avoiding legumes, fruits, and whole intact grains, as well as being less sustainable.

Triglycerides dropped more on the keto diet, no surprise. Body weight dropped the same for both diets, 7-8%. HDL-cholesterol (the “good cholesterol”) rose 11% on keto and 7% on Mediterranean diet. HgbA1c dropped the same on both diets, about 8% from baseline. Both diets lead to eating ~300 calories less per day than baseline consumption.

Dr Bret Scher addressed the increased LDL-cholesteral (aka “bad cholesterol”) over at

The authors reported that LDL “dangerously” rose 10% on the keto diet. But was it really a dangerous change? Triglycerides went down on the keto diet, as we would expect. And as we saw in 2018 with the Virta Health trial, on average, LDL went up 10%. However, the calculated cardiac risk score went down 12%. 

In terms of answering the headline question, Keto Versus Mediterranean Diet: Which Is Best for T2 Diabetics and Prediabetics, the answer really depends on long-term data concerning longevity and various diseases. This study doesn’t answer the question.

What say you?

Steve Parker, M.D.

PS: Can’t decide between Keto and Mediterranean? Why not combine the two? The best of both worlds!

Prediabetes May Not Be a Meaningful Diagnosis for those over 70


When physicians identify a patient as having prediabetes, we usually tell them they are at increased risk for actual diabetes in the next few years, and recommend steps that should reduce the risk of progression. A recent study of older folks (average age 76) suggests the risk of progression isn’t very high. In fact the odds are greater for a return to normal blood sugars, or death. The report is a little confusing because the authors used two definitions of prediabetes.

Question:  What is the risk of progression to diabetes among older adults with prediabetes (based on glycated hemoglobin level of 5.7%-6.4%, fasting glucose levels of 100-125 mg/dL, either, or both) in a community-based population?

Findings:  In this cohort study of 3412 older adults, the prevalence of prediabetes (mean [SD] age, 75.6 [5.2] years) was high and differed substantially depending on the definition used, with estimates ranging from 29% for glycated hemoglobin levels of 5.7% to 6.4% and fasting glucose levels of 100 to 125 mg/dL to 73% for either glycated hemoglobin levels of 5.7% to 6.4% or fasting glucose levels of 100 to 125 mg/dL. During the 6 years of follow-up, death or regression to normoglycemia from prediabetes was more frequent than progression to diabetes.

Meaning:  Prediabetes may not be a robust diagnostic entity in older age.

Source: Risk of Progression to Diabetes Among Older Adults With Prediabetes | Geriatrics | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Prediabetes Is Way Too Common in the Youth of U.S.A.

I’m worried about the kid’s future health

Stats from JAMA Pediatrics:

In the United States, about 1 of 5 adolescents [12–18 y.o.] and 1 of 4 young adults [19–34 y.o.] have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. – PubMed – NCBI

I’m doing my part to prevent conversion of prediabetes to type 2 diabetes. The right diet, exercise, and weight loss are just what the doctor ordered.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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