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The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein1,2,3 *

Background: The optimal source and amount of dietary carbohydrate for managing type 2 diabetes (T2DM) are unknown.

Objective: We aimed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin (HbA1c), plasma glucose, lipids, and C-reactive protein (CRP) in T2DM patients.

Design: Subjects with T2DM managed by diet alone (n = 162) were randomly assigned to receive high-carbohydrate, high-glycemic-index (high-GI), high-carbohydrate, low-glycemic-index (low-GI), or low-carbohydrate, high-monounsaturated-fat (low-CHO) diets for 1 y.

Results: The high-GI, low-GI, and low-CHO diets contained, respectively, 47%, 52%, and 39% of energy as carbohydrate and 31%, 27%, and 40% of energy as fat; they had GIs of 63, 55, and 59, respectively. Body weight and HbA1c did not differ significantly between diets. Fasting glucose was higher (P = 0.041), but 2-h postload glucose was lower (P = 0.010) after 12 mo of the low-GI diet. With the low-GI diet, overall mean triacylglycerol was 12% higher and HDL cholesterol 4% lower than with the low-CHO diet (P < 0.05), but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo (time x diet interaction, P = 0.044). Overall mean CRP with the low-GI diet, 1.95 mg/L, was 30% less than that with the high-GI diet, 2.75 mg/L (P = 0.0078); the concentration with the low-CHO diet, 2.35 mg/L, was intermediate.

Conclusions: In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA1c was not affected by altering the GI or the amount of dietary carbohydrate. Differences in total:HDL cholesterol among diets had disappeared by 6 mo. However, because of sustained reductions in postprandial glucose and CRP, a low-GI diet may be preferred for the dietary management of T2DM.

 

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As with any procedure, there could be pain or other substantial risks involved. These concerns should be discussed with your health care provider prior to any treatment so that you have proper informed consent and understand that there are no guarantees to healing.

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Published on 08-25-2009
Authors: Thomas MS Wolever, Alison L Gibbs, Christine Mehling, Jean-Louis Chiasson, Philip W Connelly, Robert G Josse, Lawrence A Leiter, Pierre Maheux, Remi Rabasa-Lhoret, N Wilson Rodger and Edmond A Ryan
Source: American Journal of Clinical Nutrition, Vol. 87, No. 1, 114-125, January 2008