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Three-graded stratification of carbohydrate restriction by level of baseline hemoglobin A1c for type 2 diabetes patients with a moderate low-carbohydrate diet.

Haimoto H, Sasakabe T, Kawamura T, Umegaki H, Komeda M, Wakai K - Nutr Metab (Lond) (2014)

Bottom Line: A fundamental issue has still to be addressed; how much carbohydrate delta-reduction (Δcarbohydrate) from baseline would be necessary to achieve a certain decrease in hemoglobin A1c (HbA1c) levels.Following three-graded carbohydrate restriction for 6 months significantly decreased mean carbohydrate intake (g/day) and HbA1c levels for all patients, from 274 ± 78 to 168 ± 52 g and from 8.1 ± 1.6 to 7.1 ± 0.9% (n = 122, P < 0.001 for both) and anti-diabetic drugs could be tapered.Also, the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels (P < 0.001), but ΔHbA1c was not significantly influenced by changes in other macronutrient intakes (g/day).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Haimoto Clinic, 1-80 Yayoi, Kasugai, Aichi 486-0838, Japan.

ABSTRACT

Background: A moderate low-carbohydrate diet has been receiving attention in the dietary management of type 2 diabetes (T2DM). A fundamental issue has still to be addressed; how much carbohydrate delta-reduction (Δcarbohydrate) from baseline would be necessary to achieve a certain decrease in hemoglobin A1c (HbA1c) levels.

Objective: We investigated the effects of three-graded stratification of carbohydrate restriction by patient baseline HbA1c levels on glycemic control and effects of Δcarbohydrate on decreases in HbA1c levels (ΔHbA1c) in each group.

Research design and methods: We treated 122 outpatients with T2DM by three-graded carbohydrate restriction according to baseline HbA1c levels (≤ 7.4% for Group 1, 7.5%-8.9% for Group 2 and ≥ 9.0% for Group 3) and assessed their HbA1c levels, doses of anti-diabetic drugs and macronutrient intakes over 6 months.

Results: At baseline, the mean HbA1c level and carbohydrate intake were 6.9 ± 0.4% and 252 ± 59 g/day for Group 1 (n = 55), 8.1 ± 0.4% and 282 ± 85 g/day for Group 2 (n = 41) and 10.6 ± 1.4% and 309 ± 88 g/day for Group 3 (n = 26). Following three-graded carbohydrate restriction for 6 months significantly decreased mean carbohydrate intake (g/day) and HbA1c levels for all patients, from 274 ± 78 to 168 ± 52 g and from 8.1 ± 1.6 to 7.1 ± 0.9% (n = 122, P < 0.001 for both) and anti-diabetic drugs could be tapered. ΔHbA1c and Δcarbohydrate were -0.4 ± 0.4% and -74 ± 69 g/day for Group 1, -0.6 ± 0.9% and -117 ± 78 g/day for Group 2 and -3.1 ± 1.4% and -156 ± 74 g/day for Group 3. Linear regression analysis showed that the greater the carbohydrate intake, the greater the HbA1c levels at baseline (P = 0.001). Also, the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels (P < 0.001), but ΔHbA1c was not significantly influenced by changes in other macronutrient intakes (g/day).

Conclusions: Three-graded stratification of carbohydrate restriction according to baseline HbA1c levels may provide T2DM patients with optimal objectives for carbohydrate restriction and prevent restriction from being unnecessarily strict.

No MeSH data available.


Related in: MedlinePlus

Changes in carbohydrate intake (g/day) between patients with less medication and those with more medication over 6 months. In 25 patients (blue lines), medication was eliminated or reduced in the study period while in 12 (orange lines), it was increased or newly started. The mean reduction in carbohydrate intake was greater in the former than in the latter, but the difference did not reach statistical significance (P = 0.095).
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Figure 5: Changes in carbohydrate intake (g/day) between patients with less medication and those with more medication over 6 months. In 25 patients (blue lines), medication was eliminated or reduced in the study period while in 12 (orange lines), it was increased or newly started. The mean reduction in carbohydrate intake was greater in the former than in the latter, but the difference did not reach statistical significance (P = 0.095).

Mentions: At baseline, 36 of the 122 patients (30%) had already been prescribed anti-diabetic drugs by other physicians (Table 4). At the end of the study, the number of patients taking anti-diabetic drugs had decreased to 17 (14%), half of the baseline number. In 25 patients, medication was eliminated or reduced in the study period while in 12, it was increased or newly started. The reduction in carbohydrate intake was greater in the former (-132 ± 86 g/day) than in the latter (-122 ± 86 g/day), but the difference did not reach statistical significance (P = 0.095) (Figure 5).


Three-graded stratification of carbohydrate restriction by level of baseline hemoglobin A1c for type 2 diabetes patients with a moderate low-carbohydrate diet.

Haimoto H, Sasakabe T, Kawamura T, Umegaki H, Komeda M, Wakai K - Nutr Metab (Lond) (2014)

Changes in carbohydrate intake (g/day) between patients with less medication and those with more medication over 6 months. In 25 patients (blue lines), medication was eliminated or reduced in the study period while in 12 (orange lines), it was increased or newly started. The mean reduction in carbohydrate intake was greater in the former than in the latter, but the difference did not reach statistical significance (P = 0.095).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4128548&req=5

Figure 5: Changes in carbohydrate intake (g/day) between patients with less medication and those with more medication over 6 months. In 25 patients (blue lines), medication was eliminated or reduced in the study period while in 12 (orange lines), it was increased or newly started. The mean reduction in carbohydrate intake was greater in the former than in the latter, but the difference did not reach statistical significance (P = 0.095).
Mentions: At baseline, 36 of the 122 patients (30%) had already been prescribed anti-diabetic drugs by other physicians (Table 4). At the end of the study, the number of patients taking anti-diabetic drugs had decreased to 17 (14%), half of the baseline number. In 25 patients, medication was eliminated or reduced in the study period while in 12, it was increased or newly started. The reduction in carbohydrate intake was greater in the former (-132 ± 86 g/day) than in the latter (-122 ± 86 g/day), but the difference did not reach statistical significance (P = 0.095) (Figure 5).

Bottom Line: A fundamental issue has still to be addressed; how much carbohydrate delta-reduction (Δcarbohydrate) from baseline would be necessary to achieve a certain decrease in hemoglobin A1c (HbA1c) levels.Following three-graded carbohydrate restriction for 6 months significantly decreased mean carbohydrate intake (g/day) and HbA1c levels for all patients, from 274 ± 78 to 168 ± 52 g and from 8.1 ± 1.6 to 7.1 ± 0.9% (n = 122, P < 0.001 for both) and anti-diabetic drugs could be tapered.Also, the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels (P < 0.001), but ΔHbA1c was not significantly influenced by changes in other macronutrient intakes (g/day).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Haimoto Clinic, 1-80 Yayoi, Kasugai, Aichi 486-0838, Japan.

ABSTRACT

Background: A moderate low-carbohydrate diet has been receiving attention in the dietary management of type 2 diabetes (T2DM). A fundamental issue has still to be addressed; how much carbohydrate delta-reduction (Δcarbohydrate) from baseline would be necessary to achieve a certain decrease in hemoglobin A1c (HbA1c) levels.

Objective: We investigated the effects of three-graded stratification of carbohydrate restriction by patient baseline HbA1c levels on glycemic control and effects of Δcarbohydrate on decreases in HbA1c levels (ΔHbA1c) in each group.

Research design and methods: We treated 122 outpatients with T2DM by three-graded carbohydrate restriction according to baseline HbA1c levels (≤ 7.4% for Group 1, 7.5%-8.9% for Group 2 and ≥ 9.0% for Group 3) and assessed their HbA1c levels, doses of anti-diabetic drugs and macronutrient intakes over 6 months.

Results: At baseline, the mean HbA1c level and carbohydrate intake were 6.9 ± 0.4% and 252 ± 59 g/day for Group 1 (n = 55), 8.1 ± 0.4% and 282 ± 85 g/day for Group 2 (n = 41) and 10.6 ± 1.4% and 309 ± 88 g/day for Group 3 (n = 26). Following three-graded carbohydrate restriction for 6 months significantly decreased mean carbohydrate intake (g/day) and HbA1c levels for all patients, from 274 ± 78 to 168 ± 52 g and from 8.1 ± 1.6 to 7.1 ± 0.9% (n = 122, P < 0.001 for both) and anti-diabetic drugs could be tapered. ΔHbA1c and Δcarbohydrate were -0.4 ± 0.4% and -74 ± 69 g/day for Group 1, -0.6 ± 0.9% and -117 ± 78 g/day for Group 2 and -3.1 ± 1.4% and -156 ± 74 g/day for Group 3. Linear regression analysis showed that the greater the carbohydrate intake, the greater the HbA1c levels at baseline (P = 0.001). Also, the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels (P < 0.001), but ΔHbA1c was not significantly influenced by changes in other macronutrient intakes (g/day).

Conclusions: Three-graded stratification of carbohydrate restriction according to baseline HbA1c levels may provide T2DM patients with optimal objectives for carbohydrate restriction and prevent restriction from being unnecessarily strict.

No MeSH data available.


Related in: MedlinePlus