http://jama.ama-assn.org/cgi/content/abstract/271/18/1421
Effects of varying carbohydrate content of diet in patients with non-
insulin-dependent diabetes mellitus
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 and al.
et
Center for Human Nutrition, University of Texas Southwestern Medical
Center at Dallas 75235-9052.
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.
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