Weight Loss, Glycemic Control, and Cardiovascular Disease Risk Factors in Response to Differential Diet Composition in a Weight Loss Program in Type 2 Diabetes: A Randomized Controlled Trial

Abstract

OBJECTIVETo test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake.RESEARCH DESIGN AND METHODSThis randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts).RESULTSRelative weight loss was 7.4% (95% CI 5.7–9.2%), 9.0% (7.1–10.9%), and 2.5% (1.3–3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI 133–149] vs. 159 [144–174] mg/dL, P = 0.023; hemoglobin A1c 6.9% [6.6–7.1%] vs. 7.5% [7.1–7.9%] or 52 [49–54] vs. 58 [54–63] mmol/mol, P = 0.001; triglycerides 148 [134–163] vs. 204 [173–234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI 6.3–6.8%] vs. 7.2% [6.8–7.5%] or 49 [45–51] vs. 55 [51–58] mmol/mol) at 1 year (P = 0.008).CONCLUSIONSThe weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial

“…These results are consistent with some previous studies (6,(8)(9)(10). However, other studies have shown greater HbA1c reductions with a very-low-carbohydrate diet (7,27,28) that could be explained by differences in energy intakes and weight loss between the very-low-carbohydrate and HC diets examined. The 1% HbA1c reduction achieved in the current study is comparable with the reductions observed in the Look AHEAD (Action for Health in Diabetes) study (from 7.3% to 6.6%) after an intensive lifestyle intervention in T2D (36).…”

“…Previous studies that compared ad libitum very-low-carbohydrate diets with calorie-restricted HC diets in T2D reported mixed results with some studies reporting greater weight loss after a very-low-carbohydrate diet (11,28), and others reporting no differential effect (6)(7)(8)10). In the current study, diets were isocalorically prescribed and achieved comparable weight loss, which suggested that the caloric deficit, independent of the macronutrient composition, is the primary determinant of weight loss.…”

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

“…Dietary intake restriction interventions in T2DM patients lead to improvements in glycaemic control, insulin sensitivity, the lipid profile, endothelial dysfunction, LV diastolic function and body composition [72][73][74][75][76]. Because some of these parameters are believed to be related to development of CI, it should thus be examined whether such an intervention will also lead to improved HR responses to exercise in T2DM patients with CI.…”

Dietas bajas en hidratos de carbono para diabéticos de tipo 2. Revisión sistemática

“…En otros 4 se encontró mayor reducción en el grupo DBCH (14,17,19,21), y en el resto no hubo diferencias entre grupos. En ningún caso se encontraron diferencias estadísticamente significativas con respecto a los niveles de colesterol total.…”