title: Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes.
abstract: OBJECTIVE
  The optimal diet for weight loss in type 2 diabetes remains controversial. This study examined a low-carbohydrate, high-fat diet with detailed physiological assessments of insulin sensitivity, glycemic control, and risk factors for cardiovascular disease.
  
  
  METHODS
  Fourteen obese patients (body mass index [BMI] 40.6 ± 4.9 kg/m(2)) with type 2 diabetes were recruited for an "Atkins"-type low-carbohydrate diet. Measurements were made at 0, 12, and 24 weeks of weight, insulin sensitivity, HbA1c, lipids, and blood pressure.
  
  
  RESULTS
  Twelve completers lost a mean of 9.7 ± 1.8 kg over 24 weeks attributable to a major reduction in carbohydrates and resultant reduction in total energy intake. Glycemic control significantly improved (HbA1c -1.1 ± 0.25%) with reductions in hypoglycemic medication. Fasting glucose, homeostasis model assessment (HOMA), and area under the curve (AUC) glucose (intravenous glucose tolerance test [IVGTT]) were significantly reduced by week 12 ( p < 0.05). There were nonsignificant improvements in insulin sensitivity (SI) at week 12 ( p = 0.19) and week 24 ( p = 0.31). Systolic blood pressure was reduced (mean -10.0 mmHg between weeks 0 and 24, p = 0.13). Mean high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol all increased. The ratio of total: HDL cholesterol and triglycerides was reduced.
  
  
  CONCLUSIONS
  A low-carbohydrate diet was well tolerated and achieved weight loss over 24 weeks in subjects with diabetes. Glycemic control improved with a reduction in requirements for hypoglycemic agents.
authors.affiliation: Endocrine, Diabetes and Research Centre, Wellington Hospital, Wellington, New Zealand. Jeremy.krebs@ccdhb.org.nz
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Krebs
authors.forename: Damon
authors.initials: D
authors.lastname: Bell
authors.forename: Rosemary
authors.initials: R
authors.lastname: Hall
authors.forename: Amber
authors.initials: A
authors.lastname: Parry-Strong
authors.forename: Paul D
authors.initials: PD
authors.lastname: Docherty
authors.forename: Kristen
authors.initials: K
authors.lastname: Clarke
authors.forename: J Geoffry
authors.initials: JG
authors.lastname: Chase
mesh_terms: D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D050528:Diet, Carbohydrate-Restricted; D059305:Diet, High-Fat; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D012307:Risk Factors; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents