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ARTICLE |

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

Abhimanyu Garg, MBBS, MD; John P. Bantle, MD; Robert R. Henry, MD; Ann M. Coulston, RD; Kay A. Griver, RD; Susan K. Raatz, MS, RD; Linda Brinkley, RD; Y-D. Ida Chen, PhD; Scott M. Grundy, MD, PhD; Beverley A. Huet, MS; Gerald M. Reaven, MD
JAMA. 1994;271(18):1421-1428. doi:10.1001/jama.1994.03510420053034.
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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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