Abstract:
Type 2 diabetes mellitus (T2DM), with its rapidly increasing incidence, is a significant
contributor to morbidity, mortality and rising healthcare costs in the United States. The
registered dietitian plays an important role in providing accurate, evidence-based dietary
strategies to treat and manage diabetes. Recent research indicates that diets resulting in
nutritional ketosis are as effective at reducing weight, and more effective at maintaining
glycemic control, than traditionally recommended low-fat, low-calorie or low-glycemic index
diets. It is not known, however, if registered dietitians recommend diets that results in nutritional
ketosis to manage T2DM. Thus, the purpose of this study was to examine the attitudes, beliefs,
and practices of registered dietitians who are members of the Indiana Academy of Nutrition and
Dietetics regarding dietary treatments for type 2 diabetes mellitus (T2DM). An anonymous
online survey was used to investigate these trends, with the results compared by frequency of
patient counseling and level of education. Results indicated that registered dietitians in Indiana
(n=199) do not recommend ketogenic diets for the treatment of T2DM, with most (92.8%)
having never recommended a ketogenic diet for T2DM. More than half (63%) indicated they do
not believe they will ever recommend nutritional ketosis to a client with diabetes. While most
dietitians reported being only moderately or slightly familiar with diets that induce nutritional
ketosis, more than half indicated they believe that evidence to support the use of a ketogenic diet
for the treatment of T2DM is inconclusive or weak. The majority of dietitians reported having
negative attitudes toward ketogenic diets, with nearly a half indicating they would be judged
negatively by their peers or colleagues if they were to recommend a ketogenic diet for the
treatment of T2DM. No differences were found among any of these constructs when compared
by educational level or frequency of counseling individuals with T2DM. However, dietitians
who counsel individuals with T2DM frequently were significantly (
=4.839, p=0.028) more
likely to report that concerns regarding side effects of ketosis would prevent them from
recommending a ketogenic diet for the treatment of T2DM. Additionally, dietitians who held
post-graduate degrees were significantly (
= 3.953, p=0.047) more likely to report that longterm dietary adherence would prevent them from recommending a ketogenic diet for the
treatment of T2DM, compared to those who held an undergraduate degree. Overall, the results of
this study aid in the understanding of the attitudes and beliefs of registered dietitians regarding
diets that cause nutritional ketosis, while also shedding light on the dietary macronutrient
compositions most frequently recommended by registered dietitians for the treatment of type 2
diabetes.
