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In type 2 diabetes, randomisation to  advice to follow a low-carbohydrate  diet transiently improves glycaemic    control ...
Pronutritionist’s background •       In recent meta-analyses low carbohydrate diets have been either         equally effec...
Methods (patients)•   Randomized trial, parallell groups, 2 years•   Primary outcomes: weight, HbA1c•   Secondary outcomes...
Methods (schematic)         Randomization         (ballots)                              20 % of energy as carbohydrates, ...
Results (macronutrients)Dietary intakes (based on food diaries)Data are given for all participants who provided complete d...
Results (fats)Dietary intakes (based on food diaries)  Dietary intakes (based on food diaries)Data are given for all parti...
Results (weight)                            The weight reduction did not differ between the groups (p =0.33               ...
Results (HbA1c)    The reduction in HbA1c level was statistically significant within the low-carbohydrate group    (p= 0.0...
Results (lipids and blood pressure)Results for only those patients who consumed ≤6,694 kJ/day (1,600 kcal/day) for women o...
Results (diverse)• No patients were lost during the follow up, all were  analysed• 7 patients did not attend all group ses...
Pronutritionist’s discussion (1/2) •    Both diets induced similar weight reductions •    HDL –cholesterol was increased i...
Pronutritionist’s discussion (2/2) •    The study shows that a long term low carbohydrate diet in type 2      diabetes may...
Please read the whole paper at              Guldbrand H et al          Diabetologia. 2012 May 6.               [Open acces...
http://twitter.com/pronutritionist             http://www.facebook.com/pronutritionist                   http://www.pronut...
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Low carb diet in diabetes, 2 year results

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Transcript of "Low carb diet in diabetes, 2 year results"

  1. 1. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Guldbrand H et al Diabetologia. 2012 May 6. [Open access]Page 1 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  2. 2. Pronutritionist’s background • In recent meta-analyses low carbohydrate diets have been either equally effective or better than low fat diets in the treatment of type 2 diabetes (Kirk et al. 2008, Kodama et al. 2009) • The trials included in these meta-analyses have been short, ie. shorter than 1 year • In non-diabetic subjects low carbohydrate diets have either been equally effective or outperformed low fat diets, when minimum 2 year trials are considered (Shai et al. 2008, Sacks et al. 2009, Foster et al. 2010, Cardillo et al. 2006) • The long terms effects on low carbohydate diets on cardiovascular risk factors, glucose and insulin parameters and weight in diabetes are not knownPage 2 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  3. 3. Methods (patients)• Randomized trial, parallell groups, 2 years• Primary outcomes: weight, HbA1c• Secondary outcomes: LDL, HDL, triglyserides, blood pressure• N=61, type 2 diabetics (BMI ∼33), free living subjects• Diets were to provide 1600 kcal for females or 1800 kcal for males (design was not ad libitum)• Diets – Carbohydrates 20 E %, ie. Low carbohydrate diet. No restriction on the use of saturated fat was given – Carbohydrates 55-60 E %, ie. Low fat diet. The diet followed the Swedish dietary guidelines for diabetics at time of commencement of the trial and saturated fat was to be stricted to the level of 10 E %• Primary care setting, dietitians provided information on diets in group meetings which took place 4 times (at baseline, 2, 4 and 12 months)• No food was provided for free• Insulin, incretin mimetics and oral diabetes drugs were allowed Page 3 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  4. 4. Methods (schematic) Randomization (ballots) 20 % of energy as carbohydrates, ie. low carb diet 2 years 55-60 of energy as carbohydrates ie, low fat dietPage 4 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  5. 5. Results (macronutrients)Dietary intakes (based on food diaries)Data are given for all participants who provided complete diet recordsaCompared with baselinebFor change over all time pointscFor changeover all time points (between groups)dDenotes statistically significant difference between changes in the two groupseDenotes statisticallysignificant difference between groups at baseline Page 5 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  6. 6. Results (fats)Dietary intakes (based on food diaries) Dietary intakes (based on food diaries)Data are given for all participants who provided complete diet recordsaCompared with baselinebFor change over all time pointscFor changeover all time points (between groups)dDenotes statistically significant difference between changes in the two groupseDenotes statisticallysignificant difference between groups at baseline Page 6 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  7. 7. Results (weight) The weight reduction did not differ between the groups (p =0.33   for all time points) Low carb diet Low fat diet7 Guldbrand H et al Diabetologia. 2012 May 6 www.pronutritionist.net
  8. 8. Results (HbA1c) The reduction in HbA1c level was statistically significant within the low-carbohydrate group (p= 0.005 for all time points), but did not differ between the groups when compared at all   time points (p= 0.76). To convert values for HbA1c in mmol/mol into %, divide by 10.929   and add 2.15 Low fat diet Low carb diet8 Guldbrand H et al Diabetologia. 2012 May 6 www.pronutritionist.net
  9. 9. Results (lipids and blood pressure)Results for only those patients who consumed ≤6,694 kJ/day (1,600 kcal/day) for women or ≤7,531 kJ/day(1,800 kcal/day) for men according to the last diet record at 24 months; 17 patients in the low-fat group and 18 patients inthe low-carbohydrate group.Data are given for all participants who provided complete diet recordsaCompared with baselinebFor change over all time pointscFor changeover all time points (between groups)dDenotes statistically significant difference between changes in the two groupseDenotes statisticallysignificant difference between groups at baseline 9 Guldbrand H et al Diabetologia. 2012 May 6 www.pronutritionist.net
  10. 10. Results (diverse)• No patients were lost during the follow up, all were analysed• 7 patients did not attend all group sessions (3 low carb and 4 in low fat group)• HDL-cholesterol increased by 33% in patients reasonably compliant with low carb diet (post hoc analysis)• Average insulin dose at 6 months was lower in low carb     diet group (p=0,046)• There were no other significant changes in drug usage• In neither group the target carbohydrate intake was reached, ie ≤ 20 E % and 55-60 E %10 Guldbrand H et al Diabetologia. 2012 May 6 www.pronutritionist.net
  11. 11. Pronutritionist’s discussion (1/2) • Both diets induced similar weight reductions • HDL –cholesterol was increased in low carbohydrate diet at all time points. No other significant differences in lipids between groups were found in spite of radical difference in macronutrient composition of diets • LDL-cholesterol did not change in either of the groups, even if the intake of saturated fat was increased in low carbohydrate group from 16 E % to 19 E % • It is noteworthy that absolute intake fat did not change in low carb (high fat) group • Low carbohydrate tended to induce bigger energy deficit than low fat diet, but the difference between the groups was not significantPage 11 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  12. 12. Pronutritionist’s discussion (2/2) • The study shows that a long term low carbohydrate diet in type 2 diabetes may not reap all the benefits demonstrated in shorter trials • The study shows that there may not be any metabolic risks in type 2 diabetes related to low carbohydrate diet in spite of the increased intake of saturated fat • The incidence of gastrointestinal side effects was not monitored and remain unknown in diabetes • The trial has a high clinical relevance because it was run with usual resources at health care centres in Nordic countries • This study suggests that low fat and low carbohydrate diets are equally effective and metabolically beneficial. The choice between the diets might be done on individual preferencePage 12 Guldbrand H et al Diabetologia. 2012 May 6 http://twitter.com/pronutritionist
  13. 13. Please read the whole paper at Guldbrand H et al Diabetologia. 2012 May 6. [Open access] Guldbrand H et al Diabetologia. 2012 May 6Page 13
  14. 14. http://twitter.com/pronutritionist http://www.facebook.com/pronutritionist http://www.pronutritionist.net Reijo Laatikainen, Authorized Nutritionist, MBA Guldbrand H et al Diabetologia. 2012 May 6 14/11/12Page 14
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