Can a Low-Carb Keto Diet Help Reverse Type 2 Diabetes? What the Research Shows

Nov 5, 2026 · @Yoon Hang Kim MD

November is American Diabetes Month — and if you or someone you love is living with type 2 diabetes, you have probably heard the buzz around low-carb and keto diets. Maybe you have seen the YouTube videos. Maybe a friend told you they "reversed" their diabetes by cutting carbs. Maybe your doctor mentioned it, or maybe they told you not to try it.

So what is actually true? Can a low-carb diet really help with type 2 diabetes — and is it safe?

I wanted to dig into this because of what I have been seeing in my own practice. Over the past several years, I have worked with a number of patients who made real, measurable improvements in their blood sugar — some even reducing or stopping diabetes medications — by following a structured, medically supervised low-carb eating plan. Not all of them. Not overnight. But enough that I felt it was worth taking a careful look at what the published research says.

What I found was encouraging, but also more nuanced than most headlines suggest. Let me walk you through it.

What Is a Low-Carb or Keto Diet — and How Does It Affect Blood Sugar?

When we eat carbohydrates — bread, rice, pasta, fruit, sugar — our body breaks them down into glucose. Glucose goes into the bloodstream, and our pancreas releases insulin to help move that glucose into our cells for energy.

In type 2 diabetes, this system stops working well. The body becomes resistant to insulin, so glucose builds up in the blood instead of getting into the cells where it is needed. Over time, the pancreas cannot keep up, and blood sugar stays high.

A low-carb diet reduces the amount of carbohydrate you eat — usually to somewhere between 20 and 130 grams per day, depending on the approach. A ketogenic (keto) diet goes further, typically below 20 to 30 grams per day. At that level, your body shifts from burning glucose for fuel to burning fat, producing molecules called ketones in the process.

The idea is straightforward: if the problem is too much glucose in the blood, and carbohydrates are what become glucose, then eating fewer carbs means less glucose for the body to deal with. In many people, blood sugar drops — sometimes quickly and dramatically.

But the question is not just whether it works in the short term. The question is: how well, for how long, and for whom?

What Does the Research Actually Say?

Two programs have produced the most important published data on low-carb diets and type 2 diabetes: Virta Health and the Duke University Keto Medicine Clinic, led by Eric Westman, MD.

Virta Health: A Five-Year Look

Virta Health studied 262 adults with type 2 diabetes who followed a medically supervised low-carb program. This was not just a diet — participants also had health coaching, telemedicine check-ins, and their medications were actively managed by clinicians.

At one year, about 60% of the people who stayed in the program brought their HbA1c (a key blood sugar marker) below 6.5% — while either stopping diabetes medications entirely or taking only metformin. That is a strong result.

At two years, the benefits held up for many participants, and medication use stayed significantly lower. By five years, about 20% of those who remained in the program met the strictest definition of diabetes remission — meaning their blood sugar stayed in a healthy range without diabetes medications for at least three months.

Twenty percent may not sound like a lot, but consider this: these were people with an average of eight years of type 2 diabetes. And even those who did not achieve full remission still had better blood sugar control on fewer medications than when they started. That matters.

The honest caveat: not everyone stayed in the program. About half of the original participants had dropped out by year five. We do not know how the people who left were doing. That limits how broadly we can apply these results.

Duke University: The Randomized Trial

Dr. Eric Westman and his colleagues at Duke ran one of the first randomized studies comparing a keto diet (under 20 grams of carbs per day) to a low-glycemic-index diet (a more moderate approach). Both groups got medical supervision and medication adjustments.

After 24 weeks, the keto group saw a 1.5-point drop in HbA1c compared with a 0.5-point drop in the other group. The keto group also lost more weight and had more participants reduce or stop diabetes medications.

This was a positive study — but it was short (only six months), and about 40% of participants dropped out before it ended. So while the results are encouraging, they do not prove that the benefits last for years.

Does It Have to Be Full Keto?

Here is where it gets interesting. A Stanford study called Keto-Med compared a strict keto diet to a Mediterranean-style diet that still included fruit, whole grains, and beans — but avoided sugar and refined carbs. Both diets improved blood sugar, and there was no significant difference in HbA1c between the two.

The takeaway: you may not need to go into full ketosis to get real metabolic benefits. Cutting way back on sugar and processed carbs — even while keeping some healthy carbs in your diet — can move the needle for many people.

"Reversal" vs. "Remission" vs. "Cure" — What Do These Words Really Mean?

This is where a lot of confusion happens — and where I think we owe patients more honesty.

Reversal is the term many programs use. Virta, for example, defines it as getting your HbA1c below 6.5% while taking no diabetes medication other than metformin. That is a very good outcome. But you are still on a medication, and if you stop the diet, your blood sugar may go right back up.

Remission is the stricter, internationally agreed-upon definition. It means your HbA1c stays below 6.5% for at least three months with no diabetes medications at all. This is closer to what most people imagine when they hear that diabetes has been "reversed."

Cure is a word most diabetes researchers avoid — and for good reason. Even in remission, the underlying tendency toward insulin resistance may remain. Blood sugar can come back. Complications still need to be monitored. Calling it a cure sets expectations that the evidence does not support.

Why does this matter to you? Because if someone tells you they can "cure" your diabetes with a diet, that is a red flag. If they tell you they can help you achieve better control — maybe even remission — with the right plan and medical supervision, that is a conversation worth having.

Why You Should Not Do This Alone

This is the part I feel most strongly about. A low-carb or keto diet is not just a food choice when you have type 2 diabetes. It is a medical intervention — and it needs to be treated like one.

Here is why:

Your medications may need to change right away. If you are on insulin or a sulfonylurea and you suddenly cut your carbs, your blood sugar can drop dangerously low. Every published study that showed good results also adjusted medications from the start — often on day one. This is not something to figure out on your own.

Some diabetes medications can become dangerous on a keto diet. SGLT2 inhibitors (medications like empagliflozin, dapagliflozin, or canagliflozin) can cause a rare but serious condition called euglycemic diabetic ketoacidosis when combined with a very low-carb diet. The tricky part: your blood sugar might look normal or only slightly high, so you might not realize anything is wrong until you are very sick.

Your cholesterol needs monitoring. While triglycerides and HDL cholesterol often improve on a low-carb diet, LDL cholesterol can go up in some people. Your doctor should be tracking this.

Nutritional quality matters. Cutting carbs does not automatically mean eating well. Fiber intake often drops. Micronutrient gaps can develop. A good plan focuses on real, whole foods — not just avoiding carbs.

You still need regular diabetes monitoring. Even if your blood sugar improves dramatically, you still need routine checkups, lab work, and screening for diabetes-related complications. Remission does not mean you are done seeing your doctor.

What I Tell My Own Patients

When someone in my practice asks me about low-carb eating for their type 2 diabetes, here is what I tell them:

The evidence is real. Carbohydrate restriction — done right, with medical supervision — can meaningfully improve your blood sugar, reduce your need for medications, and in some cases lead to remission. I have seen it happen. Not for everyone, and not without effort, but it is a legitimate tool.

But I also tell them this: the diet is only one piece. The patients I have seen do best are the ones who had their medications adjusted from the start, who had regular follow-up, who focused on real food rather than just counting carbs, and who understood that this is a long game — not a quick fix.

The most important lesson from the research is not "go keto." It is that carbohydrate restriction works best when it is delivered as structured medical care — not a DIY experiment.

If you are living with type 2 diabetes and wondering whether a low-carb approach might be right for you, I would encourage you to have that conversation with a physician who understands both the potential and the risks. This American Diabetes Month, take the time to learn what is possible — and find the right guide to help you get there safely.

Yoon Hang Kim MD is a board-certified preventive medicine physician practicing integrative and functional medicine via telemedicine across Iowa, Illinois, Missouri, Georgia, Florida, and Texas. To learn more or schedule a consultation, visit start.directintegrativecare.com