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Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial.
Diabetes Obes Metab. 2018 04; 20(4):858-871.DO

Abstract

AIM

To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D).

METHODS

A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2 ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention.

RESULTS

A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria.

CONCLUSIONS

Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.

Authors+Show Affiliations

Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia. Discipline of Medicine, University of Adelaide, Adelaide, Australia. Agency for Science, Technology and Research (A-STAR), Singapore.Discipline of Medicine, University of Adelaide, Adelaide, Australia.Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.Discipline of Medicine, University of Adelaide, Adelaide, Australia.Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina.Commonwealth Scientific and Industrial Research Organisation (CSIRO) - Health and Biosecurity, Adelaide, Australia.

Pub Type(s)

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

Language

eng

PubMed ID

29178536

Citation

Tay, Jeannie, et al. "Effects of an Energy-restricted Low-carbohydrate, High Unsaturated Fat/low Saturated Fat Diet Versus a High-carbohydrate, Low-fat Diet in Type 2 Diabetes: a 2-year Randomized Clinical Trial." Diabetes, Obesity & Metabolism, vol. 20, no. 4, 2018, pp. 858-871.
Tay J, Thompson CH, Luscombe-Marsh ND, et al. Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes Obes Metab. 2018;20(4):858-871.
Tay, J., Thompson, C. H., Luscombe-Marsh, N. D., Wycherley, T. P., Noakes, M., Buckley, J. D., Wittert, G. A., Yancy, W. S., & Brinkworth, G. D. (2018). Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. Diabetes, Obesity & Metabolism, 20(4), 858-871. https://doi.org/10.1111/dom.13164
Tay J, et al. Effects of an Energy-restricted Low-carbohydrate, High Unsaturated Fat/low Saturated Fat Diet Versus a High-carbohydrate, Low-fat Diet in Type 2 Diabetes: a 2-year Randomized Clinical Trial. Diabetes Obes Metab. 2018;20(4):858-871. PubMed PMID: 29178536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial. AU - Tay,Jeannie, AU - Thompson,Campbell H, AU - Luscombe-Marsh,Natalie D, AU - Wycherley,Thomas P, AU - Noakes,Manny, AU - Buckley,Jonathan D, AU - Wittert,Gary A, AU - Yancy,William S,Jr AU - Brinkworth,Grant D, Y1 - 2017/12/20/ PY - 2017/08/13/received PY - 2017/10/24/revised PY - 2017/11/14/accepted PY - 2017/11/28/pubmed PY - 2019/1/12/medline PY - 2017/11/28/entrez KW - dietary intervention KW - type 2 diabetes KW - weight control SP - 858 EP - 871 JF - Diabetes, obesity & metabolism JO - Diabetes Obes Metab VL - 20 IS - 4 N2 - AIM: To examine whether a low-carbohydrate, high-unsaturated/low-saturated fat diet (LC) improves glycaemic control and cardiovascular disease (CVD) risk factors in overweight and obese patients with type 2 diabetes (T2D). METHODS: A total of 115 adults with T2D (mean [SD]; BMI, 34.6 [4.3] kg/m2 ; age, 58 [7] years; HbA1c, 7.3 [1.1]%) were randomized to 1 of 2 planned energy-matched, hypocaloric diets combined with aerobic/resistance exercise (1 hour, 3 days/week) for 2 years: LC: 14% energy as carbohydrate, 28% as protein, 58% as fat (<10% saturated fat); or low-fat, high-carbohydrate, low-glycaemic index diet (HC): 53% as CHO, 17% as protein, 30% as fat (<10% saturated fat). HbA1c, glycaemic variability (GV), anti-glycaemic medication effect score (MES, calculated based on the potency and dosage of diabetes medication), weight, body composition, CVD and renal risk markers were assessed before and after intervention. RESULTS: A total of 61 (LC = 33, HC = 28) participants completed the study (trial registration: http://www.anzctr.org.au/, ANZCTR No. ACTRN12612000369820). Reductions in weight (estimated marginal mean [95% CI]; LC, -6.8 [-8.8,-4.7], HC, -6.6 [-8.8, -4.5] kg), body fat (LC, -4.3 [-6.2, -2.4], HC, -4.6 [-6.6, -2.7] kg), blood pressure (LC, -2.0 [-5.9, 1.8]/ -1.2 [-3.6, 1.2], HC, -3.2 [-7.3, 0.9]/ -2.0 [-4.5, 0.5] mmHg), HbA1c (LC, -0.6 [-0.9, -0.3], HC, -0.9 [-1.2, -0.5] %) and fasting glucose (LC, 0.3 [-0.4, 1.0], HC, -0.4 [-1.1, 0.4] mmol/L) were similar between groups (P ≥ 0.09). Compared to HC, the LC achieved greater reductions in diabetes medication use (MES; LC, -0.5 [-0.6, -0.3], HC, -0.2 [-0.4, -0.02] units; P = 0.03), GV (Continuous Overall Net Glycemic Action calculated every 1 hour (LC, -0.4 [-0.6, -0.3], HC, -0.1 [-0.1, 0.2] mmol/L; P = 0.001), and 4 hours (LC, -0.9 [-1.3, -0.6], HC, -0.2 [-0.6, 0.1] mmol/L; P = 0.02)); triglycerides (LC, -0.1 [-0.3, 0.2], HC, 0.1 [-0.2, 0.3] mmol/L; P = 0.001), and maintained HDL-C levels (LC, 0.02 [-0.05, 0.1], HC, -0.1 [-0.1, 0.01] mmol/L; P = 0.004), but had similar changes in LDL-C (LC, 0.2 [-0.1, 0.5], HC, 0.1 [-0.2, 0.4] mmol/L; P = 0.85), brachial artery flow mediated dilatation (LC, -0.5 [-1.5, 0.5], HC, -0.4 [-1.4, 0.7] %; P = 0.73), eGFR and albuminuria. CONCLUSIONS: Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management. SN - 1463-1326 UR - https://www.unboundmedicine.com/medline/citation/29178536/Effects_of_an_energy_restricted_low_carbohydrate_high_unsaturated_fat/low_saturated_fat_diet_versus_a_high_carbohydrate_low_fat_diet_in_type_2_diabetes:_A_2_year_randomized_clinical_trial_ L2 - https://doi.org/10.1111/dom.13164 DB - PRIME DP - Unbound Medicine ER -