Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.
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).


METHODS
A four-center randomized crossover trial.


METHODS
Outpatient and inpatient evaluation in metabolic units.


METHODS
Forty-two NIDDM patients receiving glipizide therapy.


METHODS
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.


METHODS
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.
Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas 75235-9052.
A
A
Garg
J P
JP
Bantle
R R
RR
Henry
A M
AM
Coulston
K A
KA
Griver
S K
SK
Raatz
L
L
Brinkley
Y D
YD
Chen
S M
SM
Grundy
B A
BA
Huet
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000178:diet therapy* / Q000188:drug therapy; D004040:Dietary Carbohydrates / Q000008:administration & dosage / Q000378:metabolism; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism; D002149:Energy Intake; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage / Q000378:metabolism; D005260:Female; D005913:Glipizide / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D005229:Fatty Acids, Monounsaturated; D007328:Insulin; D008074:Lipoproteins; D014280:Triglycerides; D005913:Glipizide