Effectiveness of the 6 × 6 Dieet® in Obese DMT2 Patients Effectiveness of a Very Low Carbohydrate Ketogenic Diet Compared to a Low Carbohydrate and Energy-Restricted Diet in Overweight/Obese Type 2 Diabetes Patients

Background: More than a million people in the Netherlands suffer from type 2 diabetes mellitus; 80 percent is overweight or obese. Weight loss through diet is important; low carb diets are increasingly popular in diabetes management. Objective: From preliminary results we concluded that the 6 × 6 dieet® (a very low carbohydrate ketogenic diet) was more effective in patients with type 2 diabetes and overweight or obesity than other diets. To prove its effectivity, we compared the 6 × 6 dieet® (6 × 6) to a moderate Low Carb Diet (LCD) and an Energy-Restricted Diabetes diet (ERD). Design: A retrospective three-arm study in dietitian practices to reduce weight; HBA1C; and use of medication in overweight/obese adults with type 2 diabetes on 6 × 6 (VLCKD); a 50-100 grams/day LCD; an energy restricted diabetes diet at 3, 6 and 12 months. Results: Data of 344 (n=110; 123; 111 in each study arm) patients from 16 practices were analyzed. More weight loss was seen in patients on 6 × 6, both at a 3, 6, and 12 months follow-up than in patients on LCD or ERD (all p-values <0.05). A total of 34.5% of patients on 6 × 6 turned their HbA1c levels to a value <43 mmol/mol after 12-months follow-up which was a higher proportion than in the LCD study arm (p=0.14) and the ERD study arm (p<0.01). The percentage of patients that stopped or reduced their use of Metformin, SU derivatives or Insulin was larger in the 6 × 6 study arm than in the LCD ad ERD study arms, reaching statistical significance when comparing 6 × 6 with ERD. Conclusions: 6 × 6 was more effective than LCD or ERD in overweight or obese patients with type 2 diabetes regarding weight loss, remission of type 2 diabetes, HbA1c-levels, and the reduction of diabetes medication.