Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.

Abstract

OBJECTIVE:

To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non-insulin-dependent diabetes mellitus (NIDDM).

DESIGN:

A four-center randomized crossover trial.

SETTING:

Outpatient and inpatient evaluation in metabolic units.

PATIENTS:

Forty-two NIDDM patients receiving glipizide therapy.

INTERVENTIONS:

A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a high-monounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks.

MAIN OUTCOME MEASURES:

Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels.

RESULTS:

The site of study as well as the diet order did not affect the results. Compared with the high-monounsaturated-fat diet, the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% (P < .0001) and 23% (P = .0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P = .03), 12% (P < .0001), and 9% (P = .02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks.

CONCLUSIONS:

In NIDDM patients, high-carbohydrate diets compared with high-monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.

• Authors: A Garg, J P Bantle, R R Henry, A M Coulston, K A Griver, S K Raatz, L Brinkley, Y D Chen, S M Grundy, B A Huet
• Journal: JAMA (JAMA) Vol. 271 Issue 18 Pg. 1421-8 (May 11 1994) ISSN: 0098-7484 [Print] United States
• PMID: 7848401 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Blood Glucose
• Dietary Carbohydrates
• Dietary Fats
• Fatty Acids, Monounsaturated
• Insulin
• Lipoproteins
• Triglycerides
• Glipizide

Topics

• Adult
• Aged
• Blood Glucose (metabolism)
• Diabetes Mellitus, Type 2 (blood, diet therapy, drug therapy)
• Dietary Carbohydrates (administration & dosage, metabolism)
• Dietary Fats (administration & dosage, metabolism)
• Energy Intake
• Fatty Acids, Monounsaturated (administration & dosage, metabolism)
• Female
• Glipizide (therapeutic use)
• Humans
• Insulin (blood)
• Lipoproteins (blood)
• Male
• Middle Aged
• Triglycerides (blood)