A continuous remote care model combining very low carbohydrate nutrition therapy with nutritional ketosis and telemedicine coaching was associated with a 20% rate of type 2 diabetes remission after five years in a cohort of motivated adults with established diabetes, defined as HbA1c below 6.5% without glucose-lowering medication for at least three months.

When dietary carbs are drastically reduced, the body switches to burning fat for fuel, producing ketones that reduce inflammation and improve how cells respond to insulin. Fat stores shrink, especially in the liver and muscles, removing substances that block insulin signaling. This allows the liver to stop making too much glucose and muscles to take up more glucose. At the same time, the pancreas gets relief from constant overwork, letting insulin-producing cells recover and start making enough insulin again to keep blood sugar normal without medication.