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Diabetes Care. 2014 Nov;37(11):2909-18. doi: 10.2337/dc14-0845. Epub 2014 Jul 28.

A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial.

Author information

  • 1Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia Discipline of Medicine, University of Adelaide, Adelaide, Australia Agency for Science, Technology and Research (A*STAR), Singapore.
  • 2Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia.
  • 3Discipline of Medicine, University of Adelaide, Adelaide, Australia.
  • 4Nutritional Physiology Research Centre, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
  • 5Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC.
  • 6Preventative Health National Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Animal, Food and Health Sciences, Adelaide, Australia grant.brinkworth@csiro.au.

Abstract

OBJECTIVE:

To comprehensively compare the effects of a very low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) with those of a high-unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease (CVD) risk factors in type 2 diabetes (T2DM).

RESEARCH DESIGN AND METHODS:

Obese adults (n = 115, BMI 34.4 ± 4.2 kg/m(2), age 58 ± 7 years) with T2DM were randomized to a hypocaloric LC diet (14% carbohydrate [<50 g/day], 28% protein, and 58% fat [<10% saturated fat]) or an energy-matched HC diet (53% carbohydrate, 17% protein, and 30% fat [<10% saturated fat]) combined with structured exercise for 24 weeks. The outcomes measured were as follows: glycosylated hemoglobin (HbA1c), glycemic variability (GV; assessed by 48-h continuous glucose monitoring), antiglycemic medication changes (antiglycemic medication effects score [MES]), and blood lipids and pressure.

RESULTS:

A total of 93 participants completed 24 weeks. Both groups achieved similar completion rates (LC 79%, HC 82%) and weight loss (LC -12.0 ± 6.3 kg, HC -11.5 ± 5.5 kg); P ≥ 0.50. Blood pressure (-9.8/-7.3 ± 11.6/6.8 mmHg), fasting blood glucose (-1.4 ± 2.3 mmol/L), and LDL cholesterol (-0.3 ± 0.6 mmol/L) decreased, with no diet effect (P ≥ 0.10). LC achieved greater reductions in triglycerides (-0.5 ± 0.5 vs. -0.1 ± 0.5 mmol/L), MES (-0.5 ± 0.5 vs. -0.2 ± 0.5), and GV indices; P ≤ 0.03. LC induced greater HbA1c reductions (-2.6 ± 1.0% [-28.4 ± 10.9 mmol/mol] vs. -1.9 ± 1.2% [-20.8 ± 13.1 mmol/mol]; P = 0.002) and HDL cholesterol (HDL-C) increases (0.2 ± 0.3 vs. 0.05 ± 0.2 mmol/L; P = 0.007) in participants with the respective baseline values HbA1c >7.8% (62 mmol/mol) and HDL-C <1.29 mmol/L.

CONCLUSIONS:

Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.

© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

PMID:
25071075
[PubMed - indexed for MEDLINE]
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