An Effective Approach to Lipid Improvement in Poorly Controlled Noninsulin Dependent Diabetes Mellitus

Abstract

Prevention of macrovascular disease is of prime importance in long-term management of noninsulin dependent diabetes s mellitus > (NIDDM). The optimization of cholesterol levels is a major factor in reducing atherogenesis; dietary modification is the prime means of achieving this goal. In this study. we compared the impact of a nomvatunal approach to diet education on lipid> with a traditional program representative of current Australian practice. NIDDM subjects in poor metabolic control with unsatisfactory diet were studied (glycosylated hemoglobin > 9.5 % , normal 6 %-9 % ; body mass index I BMI >?5; fat >35% of diet). Sixty-five subjects (28 women. 37 men: mean age 59 years, range 44-75 years, lion diet, 39 on tablets, 24 on insulin therapy) were randomly assigned to two groups. Two baaeline samples for total, high density lipoprotein (HDL) chulesterol and triglyceride levels were collected. After keeping a four-day food record, subjects were given dietary instruction within an educational program. In the motivational group, no rcference was made to saturation or source of fat: the simplitied message was to reduce all fat with a view to better blood sugar control. Weight reduction was not emphasized but recognized as a possible result of diet change. In the conventional group, weight loss and a tow-saturated fat diet were recommended. Four weks after the finish. blood samples and diet records were collected. ResultsThe gruup's mean BMI was 31+1 1 (mean±SEM). Mean initial chulesterol was 6.3±0.2 mmul/L (244±7.7 mg/dL) in the cunventional group and 7.6±0.2 mnu~l/L 12y~±7.7 mg/dl) in the motivationat The initial mean HDL levels were not different ( 1.2 mnwI/L 146 mg/dLJ in buth); the initial &dquo;risk ratius&dquo; were 5.8 and 7.5 mmot/L (224 and 290 mg/dLl, respectl%-eiv. The plasma triglvceride levels did not differ (2.3 and 2.-~'iiiiiiol/L l202 and 193 mg/ dLi, respectively). The initial fat consumptions were 42~c' and ~5''~~ of diet. The initial mean cholesterol, saturated and polyunsaturated fat intakes did not differ significantly.At ti~lluw-up, the mean fall in cholesteml was signiticantly greater in the motiBationat group l-ll.y r +I).I 1 iiiiiiol/L [-35 n +4 mg/dLI. P < .0001 ). The mean HDL level did not change aignitirantly in either, the cholesterol risk ratio thus decreased aignrticantly in the motivationat group (the change heing -l .S v +0.2 mmo)/L [-58 n +8 mg/dLI, P < .002). The triglyceride levels were not signiticantl) altered in other. The fat make in both declined ar'~nrti~antl_v, the mutivatrunal group droppIng to 30'~' of diet, while the traditional group fell to 35%: -, the change was greater in the motivational group 1-16 l~ r-7~.P < .l)001 ).The fall,, m chotcstcro) and unsaturated fat intake did not ~lrffer, %%hile saturates fat tell more in the motivationat group (-20g r-8g. P <.003).Although the nuWvatrunal program was longer < viccklj< for I weeks t' threẽ iaya), the change described were significantly better in the experimental group exaiiiined 1I11mcdiatcl) after the dict intervent...