Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial
- PMID: 19088352
- DOI: 10.1001/jama.2008.808
Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial
Abstract
Context: Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations.
Objective: To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes.
Design, setting, and participants: A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007.
Intervention: High-cereal fiber or low-glycemic index dietary advice.
Main outcome measures: Absolute change in glycated hemoglobin A(1c) (HbA(1c)), with fasting blood glucose and cardiovascular disease risk factors as secondary measures.
Results: In the intention-to-treat analysis, HbA(1c) decreased by -0.18% absolute HbA(1c) units (95% confidence interval [CI], -0.29% to -0.07%) in the high-cereal fiber diet compared with -0.50% absolute HbA(1c) units (95% CI, -0.61% to -0.39%) in the low-glycemic index diet (P < .001). There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL (95% CI, -0.9 to 0.5 mg/dL) in the high-cereal fiber diet (P = .005). The reduction in dietary glycemic index related positively to the reduction in HbA(1c) concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = -0.19, P = .009).
Conclusion: In patients with type 2 diabetes, 6-month treatment with a low-glycemic index diet resulted in moderately lower HbA(1c) levels compared with a high-cereal fiber diet. Trial Registration clinicaltrials.gov identifier: NCT00438698.
Comment in
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Low-glycemic index vs high-cereal fiber diet in type 2 diabetes.JAMA. 2009 Apr 15;301(15):1538; author reply 1538-9. doi: 10.1001/jama.2009.483. JAMA. 2009. PMID: 19366767 No abstract available.
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6-month treatment with a low-glycaemic diet was better than a high-fibre diet for glycaemic control in type 2 diabetes.Evid Based Med. 2009 Jun;14(3):72. doi: 10.1136/ebm.14.3.72. Evid Based Med. 2009. PMID: 19483021 No abstract available.
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