Effects of a 6‐month, low‐carbohydrate diet on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes: An open‐label randomized controlled trial

Abstract

Aim: To investigate the efficacy and safety of a non-calorie-restricted lowcarbohydrate diet (LCD) on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes (T2D) instructed to maintain their noninsulin antidiabetic medication and physical activity. Materials and Methods:In an open-label randomized controlled trial, patients with T2D were randomized 2:1 to either a LCD with a maximum of 20 E% (percentage of total energy intake) from carbohydrates (n = 49) or a control diet with 50-60 E% from carbohydrates (n = 22) for 6 months. Examinations at enrolment and after 3 and 6 months included blood sample analyses, anthropometrics, blood pressure, accelerometer-based assessment of physical activity, and food diaries. Total fat mass and lean mass were determined by dual-energy x-ray absorptiometry scan. The mean difference in change between groups from baseline are reported. Results:The LCD group decreased carbohydrate intake to 13.4 E% and increased fat intake to 63.2 E%, which was À30.5 ± 2.2 E% lower for carbohydrates and 30.6 ± 2.2 E% higher for fat, respectively, compared with the control group (all P < .001). The LCD reduced HbA1c after 3 months (À8.9 ± 1.7 mmol/mol; P < .0001), and this was maintained after 6 months (À7.5 ± 1.8 mmol/mol; P < .0001) compared with the control diet. The LCD also reduced weight (À3.9 ± 1.0 kg), body mass index (À1.4 ± 0.4 kg/m 2 ), and waist circumference (À4.9 ± 1.3 cm) compared with the control diet (all P < .01), accompanied by reductions in total fat mass (À2.2 ± 1.0 kg; P = .027) and lean mass (À1.3 ± 0.6 kg; P = .017). No changes in blood lipids or blood pressure were seen after 6 months. The level of physical activity was maintained, and there were no episodes of severe hypoglycaemia. Conclusion:A non-calorie-restricted LCD high in fat has significant beneficial effects on glycaemic control and body composition, and does not adversely affect cardiovascular risk factors in patients with T2D. Reducing carbohydrate intake to 10-25 E% appears to be an effective and safe nutritional approach with respect to classical cardiovascular risk factors and hypoglycaemia.

Choices of (in)action in obesity: Implications for research on treatment and prevention

“…Episodic future thinking during delay discounting tasks reduces the rate of discounting (i.e., reduction of impulsive choices) and increases the functional coupling of the ACC-hippocampus/amygdala ( 63 ). This finding is also in agreement with others showing the role of the parahippocampal gyrus in procrastination ( 71 ). Coupling between the PFC, including the ACC and hippocampal regions, is also engaged during mental simulations involving future scenarios.…”

“…For example, the consumption of different macronutrients such as carbohydrates and fats triggers the different hormonal response ( 70 ). In fact, low-carbohydrate diet have a great impact on weight loss and weight control ( 71 , 73 ). Research addressing active and passive risk taking should benefit from examining the impact initiatory behaviors regarding dietary choices and also physical activity and their associated hormonal response.…”

“…Moreover, in addition to the different roles of the PFC (i.e., ACC, vmPFC, and dlPFC) in food-related choices, there is also growing evidence suggesting that these areas and the hippocampus subserve passive risk-taking-related constructs such as procrastination and evaluation of future consequences ( 71 ). The vmPFC is implicated in maximizing gains to prevent future consequences ( 72 , 73 ).…”

Imidazole Propionate is Increased in Diabetes and Associated with Stool Consistency

“… 10 A high-protein diet can reduce HbA1c levels in T2DM patients but increase the frequency of gastrointestinal symptoms such as diarrhea and constipation with abnormal stool consistency. 34 According to our study, abnormal stool consistency can increase ImP, which explains why ImP is positively correlated with the intake of cheese, milk and eggs.…”

A practical “low-carbohydrate dietary care” model for elderly patients with type 2 diabetes mellitus

“…In addition to glycemic control, since insulin resistance in patients with T2DM increases the eagerness for carbohydrate intake, dietary interventions that reduce dietary carbohydrate intake are thought to improve glycemic control and T2DM outcomes (Gram-Kampmann et al, 2022). Interventional studies have shown that low-carbohydrate diet improves glycemic control and leads to reductions in cardiovascular disease risk in people with T2DM (Han et al, 2021).…”