Associations of carbohydrate quality and cardiovascular risk factors vary among diabetes subtypes

Cardiovasc Diabetol. 2025 Feb 6;24(1):53. doi: 10.1186/s12933-025-02580-4.

Abstract

Background: Assess the intake of carbohydrate quality and their association with cardiovascular risk factors among diabetes subtypes.

Methods: Participants of the German Diabetes Study (GDS) (recent-onset diabetes (n = 487) and 5-years thereafter (n = 209)) were allocated into severe autoimmune diabetes (SAID, 35%), severe insulin-deficient diabetes (SIDD, 3%), severe insulin-resistant diabetes (SIRD, 5%), mild obesity-related diabetes (MOD, 28%), and mild age-related diabetes (MARD, 29%). Dietary glycemic index (GI), glycemic load (GL), and intake of higher- (≥ 55) and low-GI (< 55) foods, dietary fiber, and total sugar were derived from a validated food frequency questionnaire and cross-sectionally associated with cardiovascular risk factors (blood lipids, subclinical inflammation, blood pressure, fatty liver index) using multivariable linear regression analysis for subtypes with prevalences ≥ 10%.

Results: Intake of carbohydrate quality parameters was broadly comparable between the subtypes. Among SAID higher total sugar intake was associated with lower HDL-cholesterol (ß (95% CI) relative change per 1 SD increment: - 3.4% (- 6.7; - 0.1)). No clear associations were seen among MOD. Among MARD, a higher dietary GL and higher-GI carbohydrate intake were associated with higher serum triglycerides (10.9% (2.4; 20.1), 12.4% (3.9; 21.5)) and fatty liver index (absolute change: 0.18 (0.06; 0.31), 0.17 (0.05; 0.28)) and lower HDL-cholesterol (- 4.1% (- 7.6; - 0.4), - 4.4% (- 7.8; - 0.8)), whilst higher intake of low-GI carbohydrates and dietary fiber were associated with lower high-sensitivity C-reactive protein (- 16.0% (- 25.7; - 5.1), - 13.9% (- 24.2; - 2.2)).

Conclusions: Associations of carbohydrate quality parameters with blood lipids, subclinical inflammation, and fatty liver index differed between diabetes subtypes. However, evidence is too preliminary to derive subtype-specific recommendations.

Trial registration: Clinicaltrials.gov: NCT01055093.

Keywords: Diabetes clusters; Diabetes-related complications; Glycemic index; Glycemic load.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Cardiovascular Diseases* / blood
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / epidemiology
  • Cross-Sectional Studies
  • Diabetes Mellitus* / blood
  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Dietary Carbohydrates* / administration & dosage
  • Dietary Carbohydrates* / adverse effects
  • Female
  • Germany / epidemiology
  • Glycemic Index
  • Glycemic Load
  • Heart Disease Risk Factors
  • Humans
  • Male
  • Middle Aged
  • Nutritive Value
  • Risk Assessment
  • Risk Factors
  • Time Factors

Substances

  • Biomarkers
  • Blood Glucose
  • Dietary Carbohydrates

Associated data

  • ClinicalTrials.gov/NCT01055093