Background: Debate between the Calorie Restriction (CR) and Low-Carbohydrate Diet (LCD) has been continued for several years. We have started LCD therapy for diabetic patients since 1999, and experienced good response to control hyperglycemia. Recently the risk of postprandial hyperglycemia for cardiovascular events is reported, and the range of glucose level is focused. Morbus (M) value is proposed to be a good index to show the range of glucose fluctuation. Usefulness of LCD and usefulness of M-value were shown by combined analysis. Methods: Twenty-six patients with Type 2 Diabetes Mellitus (T2DM), who admitted to the Takao Hospital, were the subjects. They were 12 males and 14 females, and their age ranged from 38 to 78 years old. A few patients were new patients, but mostly referred from other hospitals to receive LCD treatment. All patients started from CR therapy with 60% carbohydrate for 2 days, and then carried out LCD dietary therapy with 12% carbohydrates for 10-12 days. On day 2 and 12, blood glucose level was measured at 7 points a day to see the fluctuation from morning to night. Blood and urinary samples were corrected on the same day to get ordinary biochemical data and metabolic marker. Results: To know the effect of LCD on different level of HbA1c, the patients were grouped to low (L; 6.1±0.5%), middle (M; 7.9±0.4%) and high (H; 9.2±0.7%) by HbA1c value. The M-values after 2 day CR were 26.1 (L), 94.1 (M) and 343 (H), respectively. The LCD therapy decreased M-value to 10.4 (L), 18.8 (M) and 84.2 (H), respectively. The significant reduction of M-values was a reflection of the improved postprandial glucose level. LCD was effective even in the bad controlled diabetic patients. In addition to the decreased triacylglycerol and 24 hr urinary C-peptide, uric acid increased in all patients. Conclusion: Ten to 12 day-dietary therapy with LCD was quite effective to improve blood glucose profile. Patients with high HbA1c could be safely treated by LCD. Blood glucose improvement was well correlated to the M-value.

Background: The discussion concerning calorie restriction (CR) and low carbohydrate diet (LCD) has been continued for long yeas. As to LCD, we have reported lots of experience and research for glucose variability and ketone bodies.

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Background: As to nutritional therapy, continuous discussions were observed concerning calorie restriction (CR) and low-carbohydrate diet (LCD). Authors and colleagues have applied LCD for lots of diabetic patients and reported the detail relationship with ketone bodies and Morbus (M) value. Methods: Ninety-three patients with type 2 diabetes mellitus (T2DM) were considered as subjects in the study, among which 51 were male and 52 were female, 58.3±13.2 years old on average, 60 years old in median. Methods were as follows: 1) patients were admitted and provided formular diet, which included CR diet (60% carbohydrates, 1400 kcal/day) on day 1-2, and LCD (12% carbohydrate, 1400 kcal/day) on day 3-14; 2) several biomarkers on fasting were measured on day 2, 4 and 14; 3) daily profile of blood glucose were done on day 2 and day 4. Results: According to the M-value, subjects were classified into 4 groups, which were less than 25, 26-100, 101-250, more than 251, and number was 24, 24, 24, 21, respectively. The average HbA1c in 4 groups were 6.6%, 7.4%, 8.5% and 9.5% respectively. The median M-values decreased from day 2 to 4, which were 10.4 to 9.1, 53.5 to 7.7, 150 to 19.1 and 438 to 87, respectively. The average uric acid in each group revealed significant increase from day 2 to day 14. There were significant correlation between uric acid increment and creatinine increment, and among creatinine, creatinine clearance (CCr) and Cystatin C. Conclusion: LCD showed efficacy for glucose variability with significant decrease in glucose and M-value. Renal study showed increase of serum uric acid. In addition to correlations of Cystatin C and biomarkers, current results would be from some dehydrated state and/or relative decrease of total calorie intake. These findings would become the fundamental data of efficacy of LCD and its physiological influences for renal function.

BackgroundConcerning diabetic nutritional therapy, Calorie Restriction (CR) and Low Carbohydrate Diet (LCD) have been on discussion. Authors continue clinical research related to CR, LCD, Morbus(M) value and insulin secretion. Subjects and MethodsSubjects were 42 patients (63.4 years on average) with type 2 diabetes mellitus (T2DM) with its immunoreactive insulin (IRI) =<5μU/mL. Methods included CR breakfast with carbohydrate 70g (Carbo70), Insulinogenic Index (IGI) calculation and daily profile of blood glucose. ResultsSubjects showed median data; M value 207, HOMA-R 1.0, Delta Ratio of IGI for Carbo70 is 0.12 [0.08-0.22], Area under the Curves (AUC) Ratio of IGI-Carbo70 is 3.0 [2.2-4.8]. Divided into 3 groups due to HbA1c, median glucose and M value was 133mg/ dL, 227 mg/dL, 345mg/dL and 15.8, 207, 587, respectively. Delta and AUC Ratio of IGI-Carbo70 in 3 groups were 0.17, 0.10, 0.10and5.2, 2.9, 1.9, respectively. There were significant correlations between M value and Delta ratio / AUC ratio, in which the latter has higher degree of significance. Discussion and ConclusionAmong 3 groups, the distribution was overlapped in Delta-IGI, and was rather divided in AUC-IGI. Consequently, the latter method seems to be rather superior. These results would be the fundamental data, and further development of research is expected.