Abstract
ObjectiveDietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus.Research design and methodsEighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A1c.ResultsForty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).ConclusionDietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.
Highlights
The dietary macronutrient that raises postprandial serum glucose and insulin most potently is carbohydrate [1]
Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes
The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/ elimination than the low glycemic index diet
Summary
The dietary macronutrient that raises postprandial serum glucose and insulin most potently is carbohydrate [1] This observation led to the use of diets low in carbohydrate for the treatment of diabetes before insulin or other medication therapies were available [2]. Individuals who are insulin-deficient are instructed to estimate the amount of carbohydrate in the meal and to administer the insulin dosage based upon the amount of dietary carbohydrate. This strong relationship between dietary carbohydrate and postprandial serum glucose led to the development of medications that block carbohydrate absorption for the treatment of type 2 diabetes [3]. One mechanism to explain these findings is that when patients are instructed to limit carbohydrate intake to low levels without mention of caloric intake, there is an overall reduction in caloric intake [11]
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