What the Virta Health Trial Taught Us About Type 2 Diabetes

The Virta Health trial remains one of the most rigorous clinical investigations into the effects of a ketogenic diet on type 2 diabetes. Published in 2018, this open-label, non-randomised study followed 262 participants for one year, with striking results. Unlike short-term interventions, it provided evidence that carbohydrate restriction could sustain improvements in blood glucose control beyond the initial weight loss phase.

How the Trial Worked

Participants received continuous remote care, including biomarker monitoring and nutritional coaching to maintain nutritional ketosis. The control group followed standard diabetes care protocols. At £99 per month, the Virta programme represented a significant investment compared to NHS diabetes education courses, but with personalised support. Sainsbury’s and Tesco now stock keto-friendly staples like almond flour and erythritol, making the diet more accessible to British households.

Key Findings After One Year

60% of participants reversed their type 2 diabetes diagnosis (HbA1c below 6.5% without medications other than metformin). 94% reduced or eliminated insulin use. These outcomes persisted in the two-year follow-up study (Athinarayanan et al., 2019). The intervention group also saw greater improvements in weight (-12% vs -4%), triglycerides (-24% vs -5%) and HDL cholesterol (+18% vs +4%) compared to controls.

the keto adaptation timeline

What This Means in Practice

For UK residents, implementing Virta’s approach requires adjusting to British food culture. A keto breakfast might replace toast with scrambled eggs and sautéed mushrooms (£2.30 for six free-range eggs at Aldi). The trial emphasised whole foods over processed keto products, aligning with common keto electrolyte mistakes many make when starting. Seasonal UK vegetables like Brussels sprouts and kale featured heavily in meal plans.

Mechanisms Behind the Results

Ketosis appears to improve type 2 diabetes through multiple pathways (Hallberg et al., 2018): 1. Reduced hepatic glucose production 2. Improved insulin sensitivity in muscle tissue 3. Lower inflammatory markers 4. Appetite regulation through ketone bodies

Unlike calorie restriction alone, the ketogenic diet addresses the root metabolic dysfunction. Participants reported feeling less hungry despite eating fewer calories—a phenomenon supported by hormonal changes documented in other studies (Sumithran et al., 2013).

Frequently Asked Questions

Can these results be achieved without the Virta programme?

Yes, though the trial’s success relied on intensive support. The NHS now recognises low-carb diets as an option for type 2 diabetes management. Many GP practices provide basic guidance, though not the daily monitoring Virta offered.

Is nutritional ketosis safe for people with diabetes?

Under medical supervision, yes. The trial excluded those with type 1 diabetes or advanced complications. Participants on insulin required careful dose adjustments to avoid hypoglycaemia during the transition.

How does this compare to bariatric surgery outcomes?

The 60% remission rate matches many surgical studies, but without the risks of invasive procedures. However, surgery may be more effective for those with severe obesity (BMI >40).

The Bottom Line

The Virta Health trial demonstrated that sustained nutritional ketosis, supported by remote monitoring, can reverse type 2 diabetes markers in most cases. While individual results vary, the evidence challenges the assumption that diabetes progression is inevitable. If you’d rather not do the macro maths yourself, the Keto Dieting app does it for you on Google Play and the App Store.

Educational only — not medical advice. This article is for general information. Speak to your GP before changing your diet, especially if you have type 1 or type 2 diabetes, kidney or liver disease, are pregnant or breastfeeding, or take medication for blood pressure, cholesterol, or blood glucose.

References

Hallberg SJ, McKenzie AL, Williams PT, et al. (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Therapy. https://doi.org/10.1007/s13300-018-0373-9
Athinarayanan SJ, Adams RN, Hallberg SJ, et al. (2019). Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Frontiers in Endocrinology. https://doi.org/10.3389/fendo.2019.00348
Sumithran P, Prendergast LA, Delbridge E, et al. (2013). Ketosis and appetite-mediating nutrients and hormones after weight loss. European Journal of Clinical Nutrition. https://doi.org/10.1038/ejcn.2013.90