A form of early-onset diabetes, with persistent C-peptide production and negative islet cell antibodies has been reported with increasing frequency in various ethnic groups throughout the US. While insulin is often an essential part of the initial therapy of these patients, the clinical manifestations of this disease eventually become more characteristic of NIDDM. Prolonged insulin therapy may increase the risks of weight gain and progressive insulin resistance. We evaluated the use of a ketogenic very low calorie diet (VLCD) in the treatment of NIDDM in 10 African-American children (mean age 13.9±2.3 years). Patients were admitted to the General Clinical Research Center for 3-5 days, and consumed 7-800 calories daily. The ketogenic VLCD was high in protein (1.5 grams per kg of lean body mass), and contained less than 30 grams each of fat and carbohydrate. At study entry, patients had a mean BMI of 44.4±2.5 (SEM), and a HgbA1c of 8.8±0.8%. Prior to starting the diet, 5/10 were treated with insulin (mean dose = 0.49±0.20 unit/kg/day) and 3/10 were taking metformin and/or acarbose. Insulin and oral agents were weaned as preprandial blood sugars fell below 80 mg/dl, and all patients were able to discontinue medications within three days of instituting the VLCD. Upon follow-up, 1-3 months later, all but one had sustained weight loss on this diet, and 7/10 had lost more than 5 kg. Overall, BMI fell to 41.5±2.3 (p=0.02), while HgbA1c dropped to 7.6±0.9%(p<0.005), off of all pharmacologic therapies. Systolic blood pressure also declined from 133.5±3.0 to 120.5±3.0 mmHg (p=0.01).

We conclude that the ketogenic VLCD is an effective therapy for pediatric patients with NIDDM. Blood glucose control rapidly improves, allowing the discontinuation of exogenous insulin and other antidiabetic agents. This diet, although strict, offers a sound alternative to conventional therapies for this emerging subset of diabetic individuals.