Fig. 4.

Percentage of remissions of type 2 diabetes at 12 months after intervention with different diet types, stratified by study design and risk of bias. Each dot, with varying shapes to reflect risk of bias, indicates the data point for each of the studies mentioned in the main text which provided data in this form at 12 months. The column represents the mean for the diet type. Remission was defined as either HbA_1c < 48 mmol/mol (<6.5%) or fasting plasma glucose <7 mmol/l, with no glucose-lowering medication. Total diet replacement programmes included an initial low-energy formula diet, prescribed for an 8–12 week induction phase, followed by stepped food re-introduction aimed to achieve energy balance for weight loss maintenance. VLED advised a 2.9 MJ (700 kcal) food-based diet for 1 week, then dietary advice for energy intake that matched for ideal body weight. Very low-carbohydrate ketogenic diet was ad libitum intake, carbohydrate <30 g/day to achieve ketosis and 3–5 servings of non-starchy vegetables. Usual diet or standard diet interventions included diabetes education support, but no new diet intervention