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May 11, 1994

Effects of Varying Carbohydrate Content of Diet in Patients With Non—Insulin-Dependent Diabetes Mellitus

Author Affiliations

From the Center for Human Nutrition and Department of Internal Medicine (Drs Garg and Grundy) and the General Clinical Research Center (Dr Garg and Mss Brinkley and Huet), University of Texas Southwestern Medical Center at Dallas; Department of Internal Medicine, Stanford (Calif) University School of Medicine (Drs Chen and Reaven and Ms Coulston); Department of Medicine, University of Minnesota, Minneapolis (Dr Bantle and Ms Raatz); Department of Medicine, University of California—San Diego (Dr Henry); and the Veterans Affairs Medical Center, San Diego, Calif (Dr Henry and Ms Griver).

JAMA. 1994;271(18):1421-1428. doi:10.1001/jama.1994.03510420053034

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.(JAMA. 1994;271:1421-1428)

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