Both diets achieved substantial weight loss and reduced HbA1c and fasting glucose. The LC diet, which was high in unsaturated fat and low in saturated fat, achieved greater improvements in the lipid profile, blood glucose stability, and reductions in diabetes medication requirements, suggesting an effective strategy for the optimization of T2D management. This trial was registered at www.anzctr.org.au as ACTRN12612000369820.

Both diets achieved comparable weight loss and HbA1c reductions. The LC sustained greater reductions in diabetes medication requirements, and in improvements in diurnal blood glucose stability and blood lipid profile, with no adverse renal effects, suggesting greater optimization of T2D management.

OBJECTIVETo comprehensively compare the effects of a very low-carbohydrate, highunsaturated/low-saturated fat diet (LC) with those of a high-unrefined carbohydrate, low-fat diet (HC) on glycemic control and cardiovascular disease (CVD) risk factors in type 2 diabetes (T2DM). RESEARCH DESIGN AND METHODSObese adults (n = 115, BMI 34.4 6 4.2 kg/m 2 , age 58 6 7 years) with T2DM were randomized to a hypocaloric LC diet (14% carbohydrate [<50 g/day], 28% protein, and 58% fat [<10% saturated fat]) or an energy-matched HC diet (53% carbohydrate, 17% protein, and 30% fat [<10% saturated fat]) combined with structured exercise for 24 weeks. The outcomes measured were as follows: glycosylated hemoglobin (HbA 1c ), glycemic variability (GV; assessed by 48-h continuous glucose monitoring), antiglycemic medication changes (antiglycemic medication effects score [MES]), and blood lipids and pressure. RESULTSA total of 93 participants completed 24 weeks. Both groups achieved similar completion rates (LC 79%, HC 82%) and weight loss (LC 212.0 6 6.3 kg, HC 211.5 6 5.5 kg); P ‡ 0.50. Blood pressure (29.8/27.3 6 11.6/6.8 mmHg), fasting blood glucose (21.4 6 2.3 mmol/L), and LDL cholesterol (20.3 6 0.6 mmol/L) decreased, with no diet effect (P ‡ 0.10). LC achieved greater reductions in triglycerides (20.5 6 0.5 vs. 20.1 6 0.5 mmol/L), MES (20.5 6 0.5 vs. 20.2 6 0.5), and GV indices; P £ 0.03. LC induced greater HbA 1c reductions (22.6 6 1.0% [228.4 6 10.9 mmol/mol] vs. 21.9 6 1.2% [220.8 6 13.1 mmol/mol]; P = 0.002) and HDL cholesterol (HDL-C) increases (0.2 6 0.3 vs. 0.05 6 0.2 mmol/L; P = 0.007) in participants with the respective baseline values HbA 1c >7.8% (62 mmol/mol) and HDL-C <1.29 mmol/L. CONCLUSIONSBoth diets achieved substantial improvements for several clinical glycemic control and CVD risk markers. These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC. This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks.