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.
OBJECTIVE
To 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.


METHODS
This 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).


RESULTS
Relative 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).


CONCLUSIONS
The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA clrock@ucsd.edu.
Cheryl L
CL
Rock
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Shirley W
SW
Flatt
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Bilge
B
Pakiz
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Kenneth S
KS
Taylor
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Angela F
AF
Leone
HealthPartners Research Institute for Education and Research and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Kerrin
K
Brelje
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Dennis D
DD
Heath
Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA.
Elizabeth L
EL
Quintana
HealthPartners Research Institute for Education and Research and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
Nancy E
NE
Sherwood
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000378:metabolism / Q000503:physiopathology; D050177:Overweight / Q000178:diet therapy / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*; D061217:Weight Reduction Programs; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin