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Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes

Authors

  • S. B. Mayer,

    Corresponding author
    1. Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • Correspondence to: Stephanie B. Mayer, MD, Department of Medicine, Division of Endocrinology, Metabolism and Nutrition, Duke University Medical Center, DUMC 3924, Trent Drive, Baker House 227, Durham, NC 27710, USA.

      E-mail: Stephanie.b.mayer@duke.edu; stephaniebmayer@gmail.com

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  • A. S. Jeffreys,

    1. Department of Veterans' Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, USA
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  • M. K. Olsen,

    1. Department of Veterans' Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, USA
    2. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
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  • J. R. McDuffie,

    1. Department of Veterans' Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, USA
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  • M. N. Feinglos,

    1. Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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  • W. S. Yancy Jr

    1. Department of Veterans' Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, USA
    2. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Abstract

We analysed participants with type 2 diabetes (n = 46) within a larger weight loss trial (n = 146) who were randomized to 48 weeks of a low-carbohydrate diet (LCD; n = 22) or a low-fat diet + orlistat (LFD + O; n = 24). At baseline, mean body mass index (BMI) was 39.5 kg/m2 (s.d. 6.5) and haemoglobin A1c (HbA1c) 7.6% (s.d. 1.3). Although the interventions reduced BMI similarly (LCD −2.4 kg/m2; LFD + O −2.7 kg/m2, p = 0.7), LCD led to a relative improvement in HbA1c: −0.7% in LCD versus +0.2% in LFD + O [difference −0.8%, 95% confidence interval (CI) = −1.6, −0.02; p = 0.045]. LCD also led to a greater reduction in antiglycaemic medications using a novel medication effect score (MES) based on medication potency and total daily dose; 70.6% of LCD versus 30.4% LFD + O decreased their MES by ≥50% (p = 0.01). Lowering dietary carbohydrate intake demonstrated benefits on glycaemic control beyond its weight loss effects, while at the same time lowering antiglycaemic medication requirements.

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