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Monday, 1 January 2018

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


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.

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Anonymous said...

I find it all so complicated, my husband controls his blood levels by diet only. He lost twenty pounds and was then able to stop medication, the controversy between higher protein and lower carbs and then Dr. John McDougal says he has people able to stop all meds by going on a an almost pure starch diet, vegan diet, I just wish it was an easier answer, it seems everyone has different answers,, my husbands doctor actually told him take the meds don't worry about diet,, very confusing,,

Anonymous said...

It is of note to see that the results suggest that adults with prediabetes or noninsulin-dependent type 2 diabetes may be able to improve glycemic control with less medication by following an ad libitum very low-carbohydrate ketogenic diet compared to a moderate-carbohydrate, calorie-restricted low-fat diet. Additional research should examine both clinical outcomes and adherence beyond 12 months.
It is of interest that this blog, Diet Doctor site and many others talk so highly of a low carb/keto diet and enjoyment of healthy fat.

Sylvia D

Cheryl said...

So interesting.
A late friend of ours controlled his type 2 diabetes with diet alone.
He cut out carbs, sweet food, fruit, and root vegetables.
It worked for him and he lost an incredible amount of weight.

eileeninmd said...

Interesting post and info. I should have my husband read it, he is type 2.
Thanks for sharing. Enjoy your day and the week ahead!