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

JAMA. 1994 May 11;271(18):1421-8. doi: 10.1001/jama.1994.03510420053034.

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • 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.

MeSH terms

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

Substances

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