The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes

Krebs, Jeremy; Elley, C Raina; Parry‐Strong, Amber; Lunt, Helen; Drury, P. L.; Bell, Doris; Robinson, Elizabeth; Moyes, Simon; Mann, Jim

doi:10.1007/s00125-012-2461-0

Cited by 135 publications

(190 citation statements)

References 25 publications

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“…Specifically, significant reductions in HbA1c have been detected at 3 and 6 months using very low-carb or low-carb diets versus lowfat diets [47][48][49], even when there was no upper limit for SFA intake [44]. Similarly, Elhanyay et al found that a low-carb MD produced a greater improvement in HbA1c than a traditional MD or a low-fat diet at 1 year [43], whereas studies comparing diets with ≥40% carb percentage, differing mainly in protein and lipid content, have reported similar reduction rates of HbA1c at 1 year [42,45,50]. Finally, in the study by Shai et al, with a longer follow-up of 2 years, in the subgroup of individuals with diabetes, HbA1c decreased in the very low-carb group only, but not in the MD and low-fat group [27].…”

Section: Step 2: Does the Patient Have High Hba1c?mentioning

confidence: 99%

“…Specifically, a Mediterranean diet (45% carbs, 40% lipids) achieved the same improvement in HDL as a low-fat diet (60% carbs, 25% lipids) [39], implying that moderate restriction of carbohydrates may not be enough. Finally, proteins per se do not seem to be responsible for the significant changes in lipid profile; i.e., similar changes in HDL, TG, total cholesterol (TC), and TC/HDL ratio were seen when two low-fat diets (30% lipids), high or low in protein (30% vs. 15%), were compared in overweight or obese individuals with type 2 diabetes, in 3 different studies at 1 year of follow-up [45,46,50].…”

Section: Step 4: Does the Patient Have A Disturbed Lipid Profile?mentioning

confidence: 99%

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Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Koloverou

Panagiotakos

2016

Rev Diabet Stud

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■ AbstractMedical nutrition therapy constitutes an important lifestyle intervention in diabetes management. Several nutrition patterns have been effective in improving diabetes control, but there has been a debate about the optimal macronutrient composition in diabetes meal planning. For many years, the recommended diets for persons with and without diabetes were similar, i.e. heart-healthy and low in fat. For almost three decades, carbohydrates have been lauded, lipids demonized, and proteins considered of little importance. However, in the past few years, this concept has been questioned and reassessed. Modern nutritional recommendations for people with diabetes are headed towards individualization, but lack specific guidelines. Nutritional algorithms may help nutritionists in diabetes meal planning. This review aims to discuss: 1) the effects of the three major macronutrients (carbohydrates, proteins, and lipids) on glucose levels, 2) current recommendations for macronutrient intake for people with diabetes, and 3) specific parameters that need to be taken into consideration when determining the macronutrient composition for a person with diabetes, for example body mass index, degree of insulin resistance, HbA1c value, and lipid profile (especially triglycerides and HDL cholesterol). These aspects are analyzed in the context of the results of recent studies, especially randomized controlled trials (RCTs). Finally, we introduce an individualized nutritional concept that proposes carbohydrate over lipid restriction, substitution of SFAs with MUFAs and PUFAs, and adequate intake of dietary fiber, which are key factors in optimizing diabetes management.

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Section: Step 2: Does the Patient Have High Hba1c?mentioning

confidence: 99%

Section: Step 4: Does the Patient Have A Disturbed Lipid Profile?mentioning

confidence: 99%

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Koloverou

Panagiotakos

2016

Rev Diabet Stud

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“…Eine erfolgreiche Gewichtsreduktion kann nur mit einer energiereduzierten Diät, die fettreduziert, aber auch kohlenhydratereduziert sein kann oder einem mediterranen Ernährungsmuster entspricht, erreicht werden [21,22,23]. Eine mediterrane Ernährung konnte darüber hinaus die Notwendigkeit der Verordnung oraler Antidiabetika bei neu diagnostizierten Diabetikern reduzieren [24].…”

Section: Implikationen Für Das Lebensstilmanagementunclassified

Adipositas und Typ 2 Diabetes

Toplak

Hoppichler

Wascher

et al. 2016

Wien Klin Wochenschr

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Zusammenfassung Adipositas und Typ 2 Diabetes werden heute gerne unter dem Namen „Diabesity“ zusammengefasst. Das trägt dem Umstand Rechnung, dass die Adipositas dem Diabetes häufig vorangeht und wohl der wichtigste Faktor in der Zunahme des Typ 2 Diabetes mellitus ist. Der Body-Mass-Index (BMI) ist nur ein sehr grobes Maß der Körperverfettung. Sogar Normalgewichtige können bei Muskelmangel zu viel Körperfett aufweisen (Sarkopenie), weswegen Messungen des Bauchumfanges und des Körperfettes empfohlen werden (z. B. BIA). Lebensstilmanagement mit Ernährung und Bewegung ist eine der wichtigsten Maßnahmen in der Diabetesprävention. In der Therapie des Typ 2 Diabetes hat das Gewicht als sekundärer Zielparameter zunehmend Bedeutung erlangt. Auch die Wahl der antidiabetischen Therapie, aber auch der Begleittherapien, nimmt immer mehr darauf Rücksicht. Welchen Stellenwert Antiadiposita selbst in der antidiabetischen Therapie erlangen werden, wird durch zukünftige Studien zu klären sein. Die bariatrische Chirurgie ist derzeit bei einem Typ 2 Diabetes mit BMI > 35 kg/m2 indiziert und kann zumindest teilweise zur Diabetes-Remission beitragen, sie muss aber in ein entsprechendes lebenslanges Betreuungskonzept eingebunden sein.

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“…[49][50][51][52] It has been observed that a greater number of people are able to achieve weight loss of more than 10% of body weight 48 with diets moderately low in carbohydrate (eg, the South Beach diet) and during weight maintenance after weight loss these diets are more acceptable. 52,53 These studies suggest that maintenance of a reduction in energy intake remains the most critical factor in inducing weight loss but lower carbohydrate, higher protein diets may confer some advantage in improving compliance in the long-term.…”

Section: Weight Lossmentioning

confidence: 99%

Importance of low carbohydrate diets in diabetes management

Hall¹,

Parry‐Strong²,

Krebs³

2016

NDS

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Dietary strategies are fundamental in the management of diabetes. Historically, strict dietary control with a low carbohydrate diet was the only treatment option. With increasingly effective medications, the importance of dietary change decreased. Recommendations focused on reducing dietary fat to prevent atherosclerotic disease, with decreasing emphasis on the amount and quality of carbohydrate. As the prevalence of obesity and diabetes escalates, attention has returned to the macronutrient composition of the diet. Very low carbohydrate diets (VLCD's) have demonstrated effective initial weight loss and improvement in glycemic control, but difficult long-term acceptability and worsening lipid profile. Modifications to the very low carbohydrate (VLC) have included limiting saturated fat and increasing carbohydrate (CHO) and protein.Reducing saturated fat appears pivotal in reducing low-density lipoprotein (LDL) cholesterol and may mitigate adverse effects of traditional VLCD's. Increased dietary protein enhances satiety, reduces energy intake, and improves glycemic homeostasis, but without sustained improvements in glycemic control or cardiovascular risk over and above the effect of weight loss. Additionally, recent studies in type 1 diabetes mellitus suggest promising benefits to diabetes control with low carbohydrate diets, without concerning effects on ketosis or hypoglycemia. Dietary patterns may highlight pertinent associations. For example, Mediterranean-style and paleolithic-type diets, low in fat and carbohydrate, are associated with reduced body weight and improved glycemic and cardiovascular outcomes in type 2 diabetes mellitus (T2DM). A feature of these dietary patterns is low refined CHO and sugar and higher fiber, and it is possible that increasing sugar consumption is having a substantial effect on global escalations in obesity and T2DM. Dietary recommendations in type 1 diabetes and T2DM are changing. Dietary CHO is unquestionably important, but long-term acceptability of any diet is critical to sustain improvements in health benefits. Personalized dietary management, using a variety of dietary approaches, may be the key to optimal diabetes outcomes.

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The Diabetes Excess Weight Loss (DEWL) Trial: a randomised controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes

Abstract: In a 'real-world' setting, prescription of an energy-reduced low-fat diet, with either increased protein or carbohydrate, results in similar modest losses in weight and waist circumference over 2 years

Cited by 135 publications

References 25 publications

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Macronutrient Composition and Management of Non-Insulin-Dependent Diabetes Mellitus (NIDDM): A New Paradigm for Individualized Nutritional Therapy in Diabetes Patients

Adipositas und Typ 2 Diabetes

Importance of low carbohydrate diets in diabetes management

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