This 2018 study followed 262 adults with type 2 diabetes using a continuous-care program built around sustained carbohydrate restriction and nutritional ketosis, comparing them with 87 adults receiving usual diabetes care. After one year, the intervention group lost substantial weight and improved blood glucose control while also showing lower triglycerides, higher HDL, fewer small LDL particles, larger LDL particle size, lower blood pressure, and substantial reductions in inflammatory markers. Their calculated 10-year cardiovascular risk fell by 11.9%, and many participants were able to discontinue antihypertensive medications. The usual-care group showed no significant improvements.

Notably, LDL cholesterol increased by about 10%, but ApoB and total LDL particle number did not significantly increase, while several other markers of atherogenic dyslipidemia improved. The study therefore challenges the assumption that the LDL-C increase sometimes seen with carbohydrate restriction necessarily represents an overall worsening of cardiovascular risk. However, the study was not randomized, the intervention included intensive medical and coaching support in addition to carbohydrate restriction, and one year was too short to determine whether these changes ultimately reduced heart attacks, cardiovascular deaths, or other clinical events.

https://link.springer.com/article/10.1186/s12933-018-0698-8