Retrospective Analysis of Metabolic Control in Type 2 Diabetes with American Diabetes Association Recommendations compared with Carbohydrate Restriction

Background/Synopsis

The prevalence of type 2 diabetes mellitus has increased dramatically over the last several decades. Following diagnosis, diabetes has historically been approached as a disease that will progress over time requiring increased oral medications and eventual insulin therapy. However, several recent studies indicate that diabetes improvement can occur with fewer medications with either significant calorie restriction or macronutrient manipulation.

Objective/Purpose

This study was designed to retrospectively assess the effectiveness of the Indiana University (IU) Medical Weight Loss Program (IU-MWLP), which is based on carbohydrate restriction, to improve indices of metabolic health, compared to a standard of care program based on the American Diabetes Association (ADA) diabetes management program.

Methods

IRB approved diabetic patient lists were obtained from the IU Health electronic medical record department who had either started the medical weight loss program or seen the diabetic dieticians in the first seven months of 2014. Patients were entered into the study in consecutive order as they met the inclusion criteria of available pre and post labs in a set time frame until a total of 50 patients in each group were obtained. Weight, BMI, hemoglobin A1c, serum transaminases, creatinine, and fasting lipid profiles were recorded along with diabetic medication use.

Results

Over time, body weight, blood pressure, and serum triglyceride responses were different (p<0.05) between patients in the IU -MWLP vs. ADA groups (BW -8.8±1.1 vs. -1.1±0.7 kg; SBP -4.9±2.4 vs. 2.6±2.0 mmHg; DBP -5.4±1.6 vs. 1.8±1.6 mmHg; TG -10.9±12.0 vs. 51.5±29.4 mg/dL). Serum creatinine and aspartate aminotransferase (AST) showed statistically significant decreases in IU-MWLP, but not ADA. Hemoglobin A1c decreased in both groups (-0.54±-.16 vs. -0.51±0.18 %), with no difference in response between groups. Patients in the low carbohydrate group had a considerable number of medications removed or decreased compared to the ADA group.

Conclusions

Within the IU Health system, the IU-Medical Weight Loss Program more effectively reduced patient body weight and improved selected indices of metabolic health than an ADA-based diabetes management program. These findings provide a scientific foundation to continue to assess the effectiveness of this low carbohydrate nutrition plan for diabetes therapy, including both clinical and financial impact to care.

http://www.lipidjournal.com/

One of the authors of this study is Dr Sarah Hallberg who featured on the TEDx video "Reversing Type 2 diabetes starts with ignoring the guidelines" https://www.youtube.com/

Graham