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The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein.
Am J Clin Nutr 2008; 87(1):114-25AJ

Abstract

BACKGROUND

The optimal source and amount of dietary carbohydrate for managing type 2 diabetes (T2DM) are unknown.

OBJECTIVE

We aimed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin (HbA1c), plasma glucose, lipids, and C-reactive protein (CRP) in T2DM patients.

DESIGN

Subjects with T2DM managed by diet alone (n=162) were randomly assigned to receive high-carbohydrate, high-glycemic-index (high-GI), high-carbohydrate, low-glycemic-index (low-GI), or low-carbohydrate, high-monounsaturated-fat (low-CHO) diets for 1 y.

RESULTS

The high-GI, low-GI, and low-CHO diets contained, respectively, 47%, 52%, and 39% of energy as carbohydrate and 31%, 27%, and 40% of energy as fat; they had GIs of 63, 55, and 59, respectively. Body weight and HbA1c did not differ significantly between diets. Fasting glucose was higher (P=0.041), but 2-h postload glucose was lower (P=0.010) after 12 mo of the low-GI diet. With the low-GI diet, overall mean triacylglycerol was 12% higher and HDL cholesterol 4% lower than with the low-CHO diet (P<0.05), but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo (time x diet interaction, P=0.044). Overall mean CRP with the low-GI diet, 1.95 mg/L, was 30% less than that with the high-GI diet, 2.75 mg/L (P=0.0078); the concentration with the low-CHO diet, 2.35 mg/L, was intermediate.

CONCLUSIONS

In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate. Differences in total:HDL cholesterol among diets had disappeared by 6 mo. However, because of sustained reductions in postprandial glucose and CRP, a low-GI diet may be preferred for the dietary management of T2DM.

Authors+Show Affiliations

Department of Nutritional Sciences, University of Toronto, and the Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada. thomas.wolever@utoronto.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18175744

Citation

Wolever, Thomas M S., et al. "The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y Controlled Trial of Low-glycemic-index Dietary Carbohydrate in Type 2 Diabetes: No Effect On Glycated Hemoglobin but Reduction in C-reactive Protein." The American Journal of Clinical Nutrition, vol. 87, no. 1, 2008, pp. 114-25.
Wolever TM, Gibbs AL, Mehling C, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008;87(1):114-25.
Wolever, T. M., Gibbs, A. L., Mehling, C., Chiasson, J. L., Connelly, P. W., Josse, R. G., ... Ryan, E. A. (2008). The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. The American Journal of Clinical Nutrition, 87(1), pp. 114-25.
Wolever TM, et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y Controlled Trial of Low-glycemic-index Dietary Carbohydrate in Type 2 Diabetes: No Effect On Glycated Hemoglobin but Reduction in C-reactive Protein. Am J Clin Nutr. 2008;87(1):114-25. PubMed PMID: 18175744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. AU - Wolever,Thomas M S, AU - Gibbs,Alison L, AU - Mehling,Christine, AU - Chiasson,Jean-Louis, AU - Connelly,Philip W, AU - Josse,Robert G, AU - Leiter,Lawrence A, AU - Maheux,Pierre, AU - Rabasa-Lhoret,Remi, AU - Rodger,N Wilson, AU - Ryan,Edmond A, PY - 2008/1/8/pubmed PY - 2008/2/29/medline PY - 2008/1/8/entrez SP - 114 EP - 25 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 87 IS - 1 N2 - BACKGROUND: The optimal source and amount of dietary carbohydrate for managing type 2 diabetes (T2DM) are unknown. OBJECTIVE: We aimed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin (HbA1c), plasma glucose, lipids, and C-reactive protein (CRP) in T2DM patients. DESIGN: Subjects with T2DM managed by diet alone (n=162) were randomly assigned to receive high-carbohydrate, high-glycemic-index (high-GI), high-carbohydrate, low-glycemic-index (low-GI), or low-carbohydrate, high-monounsaturated-fat (low-CHO) diets for 1 y. RESULTS: The high-GI, low-GI, and low-CHO diets contained, respectively, 47%, 52%, and 39% of energy as carbohydrate and 31%, 27%, and 40% of energy as fat; they had GIs of 63, 55, and 59, respectively. Body weight and HbA1c did not differ significantly between diets. Fasting glucose was higher (P=0.041), but 2-h postload glucose was lower (P=0.010) after 12 mo of the low-GI diet. With the low-GI diet, overall mean triacylglycerol was 12% higher and HDL cholesterol 4% lower than with the low-CHO diet (P<0.05), but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo (time x diet interaction, P=0.044). Overall mean CRP with the low-GI diet, 1.95 mg/L, was 30% less than that with the high-GI diet, 2.75 mg/L (P=0.0078); the concentration with the low-CHO diet, 2.35 mg/L, was intermediate. CONCLUSIONS: In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate. Differences in total:HDL cholesterol among diets had disappeared by 6 mo. However, because of sustained reductions in postprandial glucose and CRP, a low-GI diet may be preferred for the dietary management of T2DM. SN - 0002-9165 UR - https://www.unboundmedicine.com/medline/citation/18175744/The_Canadian_Trial_of_Carbohydrates_in_Diabetes__CCD__a_1_y_controlled_trial_of_low_glycemic_index_dietary_carbohydrate_in_type_2_diabetes:_no_effect_on_glycated_hemoglobin_but_reduction_in_C_reactive_protein_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/87.1.114 DB - PRIME DP - Unbound Medicine ER -