OBJECTIVETo compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSThis study is a randomized clinical trial of 105 overweight adults with type 2 diabetes. Primary outcomes were weight and A1C. Secondary outcomes included blood pressure and lipids. Outcome measures were obtained at 3, 6, and 12 months.RESULTSThe greatest reduction in weight and A1C occurred within the first 3 months. Weight loss occurred faster in the low-carbohydrate group than in the low-fat group (P = 0.005), but at 1 year a similar 3.4% weight reduction was seen in both dietary groups. There was no significant change in A1C in either group at 1 year. There was no change in blood pressure, but a greater increase in HDL was observed in the low-carbohydrate group (P = 0.002).CONCLUSIONSAmong patients with type 2 diabetes, after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet. There was no significant effect on blood pressure, but the low-carbohydrate diet produced a greater increase in HDL cholesterol.

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Objective Although tight glucose control is widely used in hospitalized patients, there is concern that medication-induced hypoglycemia may worsen patient outcomes. We sought to determine if the mortality risk associated with hypoglycemia in hospitalized non-critically ill patients is linked to glucose-lowering medications (drug-associated hypoglycemia) or if it is merely an association mediated by comorbidities (spontaneous hypoglycemia). Methods Retrospective cohort of patients admitted to the general wards of an academic center during 2007. The in-hospital mortality risk of a hypoglycemic group (at least one blood glucose ≤ 70 mg/dl) was compared to that of a normoglycemic group using survival analysis. Stratification by subgroups of patients with spontaneous and drug-associated hypoglycemia was performed. Results Among 31,970 patients, 3,349 (10.5%) had at least one episode of hypoglycemia. Patients with hypoglycemia were older, had more comorbidities, and received more antidiabetic agents. Hypoglycemia was associated with increased in-hospital mortality (HR: 1.67, 95% CI, 1.33 to 2.09, p<0.001). However, this greater risk was limited to patients with spontaneous hypoglycemia (HR: 2.62, 95% CI, 1.97 to 3.47, p<0.001), not to those with drug-associated hypoglycemia (HR: 1.06, 95% CI, 0.74 to 1.52, p=0.749). After adjustment for patient comorbidities, the association between spontaneous hypoglycemia and mortality was eliminated (HR: 1.11, 95% CI, 0.76 to 1.64, p=0.582). Conclusions Drug-associated hypoglycemia was not associated with increased mortality risk in patients admitted to the general wards. The association between spontaneous hypoglycemia and mortality was eliminated after adjustment for comorbidities, suggesting that hypoglycemia may be a marker of disease burden rather than a direct cause of death.