Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes - PubMed (original) (raw)

Randomized Controlled Trial

doi: 10.1038/s41387-017-0006-9.

Jennifer J Daubenmier 2, Judith T Moskowitz 3, Sarah Kim 4, Elizabeth J Murphy 4, Stephen D Phinney 5, Robert Ploutz-Snyder 6, Veronica Goldman 4, Rachel M Cox 7, Ashley E Mason 4, Patricia Moran 4, Frederick M Hecht 4

Affiliations

Randomized Controlled Trial

Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes

Laura R Saslow et al. Nutr Diabetes. 2017.

Abstract

Dietary treatment is important in management of type 2 diabetes or prediabetes, but uncertainty exists about the optimal diet. We randomized adults (n = 34) with glycated hemoglobin (HbA1c) > 6.0% and elevated body weight (BMI > 25) to a very low-carbohydrate ketogenic (LCK) diet (n = 16) or a moderate-carbohydrate, calorie-restricted, low-fat (MCCR) diet (n = 18). All participants were encouraged to be physically active, get sufficient sleep, and practice behavioral adherence strategies based on positive affect and mindful eating. At 12 months, participants in the LCK group had greater reductions in HbA1c levels (estimated marginal mean (EMM) at baseline = 6.6%, at 12 mos = 6.1%) than participants in MCCR group (EMM at baseline = 6.9%, at 12 mos = 6.7%), p = .007. Participants in the LCK group lost more weight (EMM at baseline = 99.9 kg, at 12 mos = 92.0 kg) than participants in the MCCR group (EMM at baseline = 97.5 kg, at 12 mos = 95.8 kg), p < .001. The LCK participants experienced larger reductions in diabetes-related medication use; of participants who took sulfonylureas or dipeptidyl peptidase-4 inhibitors at baseline, 6/10 in the LCK group discontinued these medications compared with 0/6 in the MCCR group (p = .005). In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.

PubMed Disclaimer

Conflict of interest statement

Stephen Phinney is a paid member of the Atkins Scientific Advisory Board, a founder of Virta Health, and has authored books on low-carbohydrate, high fat diets: New Atkins and You, The Art and Science of Low Carbohydrate Living, and The Art and Science of Low Carbohydrate Performance. Frederick Hecht is on the Scientific Advisory Board for Virta Health. The other authors declare no competing financial interests.

Figures

Fig. 1

Fig. 1. Mean and individual HbA1c for the two groups at baseline and at 6 and 12 months

Bars represent standard 95% confidence intervals of the mean. Dashed lines reflect individual participant observations; darker lines represent each group mean

References

    1. Feinman RD, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015;31:1–13. doi: 10.1016/j.nut.2014.06.011. - DOI - PubMed
    1. Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009;44:297–309. doi: 10.1007/s11745-008-3274-2. - DOI - PubMed
    1. Ruskin DN, Masino SA. The nervous system and metabolic dysregulation: emerging evidence converges on ketogenic diet therapy. Front Neurosci. 2012;6:33. doi: 10.3389/fnins.2012.00033. - DOI - PMC - PubMed
    1. Dashti HM, et al. Beneficial effects of ketogenic diet in obese diabetic subjects. Mol. Cell. Biochem. 2007;302:249–256. doi: 10.1007/s11010-007-9448-z. - DOI - PubMed
    1. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann. Intern. Med. 2005;142:403–411. doi: 10.7326/0003-4819-142-6-200503150-00006. - DOI - PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources