A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes.
We compared the effects of two diets on glycated hemoglobin (HbA1c) and other health-related outcomes in overweight or obese adults with type 2 diabetes or prediabetes (HbA1c>6%). We randomized participants to either a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet (MCCR) consistent with guidelines from the American Diabetes Association (n = 18) or a very low carbohydrate, high fat, non calorie-restricted diet whose goal was to induce nutritional ketosis (LCK, n = 16). We excluded participants receiving insulin; 74% were taking oral diabetes medications. Groups met for 13 sessions over 3 months and were taught diet information and psychological skills to promote behavior change and maintenance. At 3 months, mean HbA1c level was unchanged from baseline in the MCCR diet group, while it decreased 0.6% in the LCK group; there was a significant between group difference in HbA1c change favoring the LCK group (-0.6%, 95% CI, -1.1% to -0.03%, p = 0.04). Forty-four percent of the LCK group discontinued one or more diabetes medications, compared to 11% of the MCCR group (p = 0.03); 31% discontinued sulfonylureas in the LCK group, compared to 5% in the MCCR group (p = 0.05). The LCK group lost 5.5 kg vs. 2.6 kg lost in MCCR group (p = 0.09). Our results suggest that a very low carbohydrate diet coupled with skills to promote behavior change may improve glycemic control in type 2 diabetes while allowing decreases in diabetes medications. This clinical trial was registered with ClinicalTrials.gov, number NCT01713764.
University of California San Francisco, San Francisco, California, United States of America.
Laura R
LR
Saslow
University of California San Francisco, San Francisco, California, United States of America.
Sarah
S
Kim
University of California San Francisco, San Francisco, California, United States of America.
Jennifer J
JJ
Daubenmier
University of California San Francisco, San Francisco, California, United States of America.
Judith T
JT
Moskowitz
UC Davis School of Medicine (Emeritus), Davis, California, United States of America.
Stephen D
SD
Phinney
University of California San Francisco, San Francisco, California, United States of America.
Veronica
V
Goldman
University of California San Francisco, San Francisco, California, United States of America.
Elizabeth J
EJ
Murphy
Children's Hospital and Research Center, Oakland, California, United States of America.
Rachel M
RM
Cox
University of California San Francisco, San Francisco, California, United States of America.
Patricia
P
Moran
University of California San Francisco, San Francisco, California, United States of America.
Fredrick M
FM
Hecht
D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000178:diet therapy* / Q000523:psychology; D050528:Diet, Carbohydrate-Restricted; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000178:diet therapy* / Q000523:psychology; D011236:Prediabetic State / Q000097:blood / Q000150:complications / Q000178:diet therapy*; D014280:Triglycerides / Q000378:metabolism
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D014280:Triglycerides