Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes

Diabetes Care. 1999 Jun;22(6):889-95. doi: 10.2337/diacare.22.6.889.


Objective: To determine the optimal diet for improving glucose and lipid profiles in obese patients with type 2 diabetes during moderate energy restriction.

Research design and methods: A total of 35 free-living obese patients with type 2 diabetes were assigned to one of three 1,600 kcal/day diets for 12 weeks. The diets were high carbohydrate (10% fat, 4% saturated), high monounsaturated fat (MUFA) (32% fat, 7% saturated), or high saturated fat (SFA) (32% fat, 17% saturated).

Results: Diet composition did not affect the magnitude of weight loss, with subjects losing an average of 6.6 +/- 0.9 kg. Energy restriction and weight loss resulted in reductions in fasting plasma glucose (-14%), insulin (-27%), GHb (-14%), and systolic (-7%) and diastolic blood pressure (-10%) levels and the glucose response area (-17%) independent of diet composition. Diet composition did affect the lipoprotein profile. LDL was 10% and 17% lower with the high-carbohydrate and high-MUFA diets, respectively, whereas no change was observed with the high-SFA diet (P < 0.001 for effect of diet). HDL was transiently reduced on the high-carbohydrate diet at weeks 1, 4, and 8, whereas higher fat consumption maintained these levels. The total cholesterol:HDL ratio, although significantly reduced on the high-MUFA diet (P < 0.01), was not different from the other two diets after adjustment for baseline differences.

Conclusions: Energy restriction, independent of diet composition, improves glycemic control; however, reducing SFA intake by replacing SFA with carbohydrate or MUFA reduces LDL maximally during weight loss and to a greater degree than has been shown in weight-stable studies.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial

MeSH terms

  • Blood Glucose / metabolism
  • Blood Pressure
  • Body Mass Index
  • Cholesterol, Dietary
  • Diabetes Mellitus / diet therapy*
  • Diabetes Mellitus / physiopathology
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diet, Diabetic*
  • Diet, Reducing*
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Fiber
  • Dietary Proteins
  • Female
  • Humans
  • Lipids / blood
  • Lipoproteins / blood
  • Male
  • Middle Aged
  • Obesity*
  • Weight Loss*


  • Blood Glucose
  • Cholesterol, Dietary
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Fiber
  • Dietary Proteins
  • Lipids
  • Lipoproteins