title: Weight Loss, Glycemic Control, and Cardiovascular Disease Risk Factors in Response to Differential Diet Composition in a Weight Loss Program in Type 2 Diabetes: A Randomized Controlled Trial In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss Targeting dietary fat or glycemic load in the treatment of obesity and type 2 diabetes: a randomized controlled trial. A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. A low-carbohydrate as compared with a low-fat diet in severe obesity. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. One-Year Comparison of a High–Monounsaturated Fat Diet With a High-Carbohydrate Diet in Type 2 Diabetes Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction. Effect of a Mediterranean diet on endothelial progenitor cells and carotid intima-media thickness in type 2 diabetes: Follow-up of a randomized trial The effect of three different ad libitum diets for weight loss maintenance: a randomized 18-month trial An Online Intervention Comparing a Very Low-Carbohydrate Ketogenic Diet and Lifestyle Recommendations Versus a Plate Method Diet in Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Mechanisms of increase in plasma triacylglycerol concentrations as a result of high carbohydrate intakes in patients with non-insulin-dependent diabetes mellitus. 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 protein. Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes. Fatty acid composition of platelet phospholipids in non-insulin-dependent diabetics randomized for dietary advice. Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus [Favourable effect of olive oil in patients with non-insulin-dependent diabetes. The effect on blood pressure, blood glucose and lipid levels of a high-fat diet rich in monounsaturated fat compared with a carbohydrate-rich diet]. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. The insulin resistance phenotype (muscle or liver) interacts with the type of diet to determine changes in disposition index after 2 years of intervention: the CORDIOPREV-DIAB randomised clinical trial The Effects of a Mediterranean Diet on the Need for Diabetes Drugs and Remission of Newly Diagnosed Type 2 Diabetes: Follow-up of a Randomized Trial Effects of a Monounsaturated Fatty Acid–Enriched Hypocaloric Diet on Cardiovascular Risk Factors in Obese Patients With Type 2 Diabetes Adverse effects on insulin secretion of replacing saturated fat with refined carbohydrate but not with monounsaturated fat: A randomized controlled trial in centrally obese subjects. Dietary composition affects regional body fat distribution and levels of dehydroepiandrosterone sulphate (DHEAS) in post-menopausal women with Type 2 diabetes Long-term effects of popular dietary approaches on weight loss and features of insulin resistance Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity. Long-Term Comparison of Three Dietary Prescriptions in the Treatment of NIDDM A Randomized Controlled Trial of a Mini Low-Carbohydrate Diet and an Energy-Controlled Diet Among Japanese Patients With Type 2 Diabetes Personalized Nutrition by Prediction of Glycemic Responses ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Liver Fat Is Reduced by an Isoenergetic MUFA Diet in a Controlled Randomized Study in Type 2 Diabetic Patients The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus Comparative Study of the Effects of a 1-Year Dietary Intervention of a Low-Carbohydrate Diet Versus a Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetes High carbohydrate-high fibre diets in poorly controlled diabetes. Lipoprotein compositional changes in the fasting and postprandial state on a high-carbohydrate low-fat and a high-fat diet in subjects with noninsulin-dependent diabetes mellitus. Dietary Composition, Body Weight, and NIDDM: Comparison of high-fiber, high-carbohydrate, and modified-fat diets Why Do Low-Fat High-Carbohydrate Diets Accentuate Postprandial Lipemia in Patients With NIDDM? Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. One-year weight maintenance after significant weight loss in healthy overweight and obese subjects: does diet composition matter? Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes. A randomised controlled trial of the effect of low fat diet advice on dietary response in insulin independent diabetic women Effect of a high-carbohydrate versus a high--cis-monounsaturated fat diet on blood pressure in patients with type 2 diabetes. Prospective comparison of modified fat-high-carbohydrate with standard low-carbohydrate dietary advice in the treatment of diabetes: one year follow-up study. Increased arachidonic acid level in diabetic platelets following improvement in diabetic control. Persistence of Hypertriglyceridemic Effect of Low-Fat High-Carbohydrate Diets in NIDDM Patients Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Insulin receptor binding increased by high carbohydrate low fat diet in non-insulin-dependent diabetics. A HIGH CARBOHYDRATE LEGUMINOUS FIBRE DIET IMPROVES ALL ASPECTS OF DIABETIC CONTROL Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes--a randomized controlled trial. Clinical Efficacy of Two Hypocaloric Diets That Vary in Overweight Patients With Type 2 Diabetes Effect of weight reduction on the distribution of apolipoprotein A-I in high-density lipoprotein subfractions in obese non-insulin-dependent diabetic subjects. Physical Activity and Fibrinogen Concentration in Newly Diagnosed NIDDM Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Lasting improvement of hyperglycaemia and bodyweight: low-carbohydrate diet in type 2 diabetes. A brief report. Effects of a low-intensity intervention that prescribed a low-carbohydrate vs. a low-fat diet in obese, diabetic participants. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. A Very Low-Carbohydrate, Low–Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels! Decreased Insulin Requirement and Improved Control of Diabetes in Pregnant Women Given a High-Carbohydrate, High-Fiber, Low-Fat Diet
abstract: OBJECTIVE To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake . RESEARCH DESIGN AND METHODS This r and omized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) . RESULTS Relative weight loss was 7.4 % ( 95 % CI 5.7–9.2 % ) , 9.0 % ( 7.1–10.9 % ) , and 2.5 % ( 1.3–3.8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) . Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133–149 ] vs. 159 [ 144–174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6–7.1 % ] vs. 7.5 % [ 7.1–7.9 % ] or 52 [ 49–54 ] vs. 58 [ 54–63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134–163 ] vs. 204 [ 173–234 ] mg/dL , P < 0.001 ) . The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3–6.8 % ] vs. 7.2 % [ 6.8–7.5 % ] or 49 [ 45–51 ] vs. 55 [ 51–58 ] mmol/mol ) at 1 year ( P = 0.008 ) . CONCLUSIONS The weight loss program result ed in greater weight loss and improved glycemic control in type 2 diabetes Aims /hypothesisThe study aim ed to compare the effects of a 2 year intervention with a low-fat diet ( LFD ) or a low-carbohydrate diet ( LCD ) , based on four group meetings to achieve compliance . Methods This was a prospect i ve r and omised parallel trial involving 61 adults with type 2 diabetes consecutively recruited in primary care and r and omised by drawing ballots . Patients that did not speak Swedish could not be recruited . The primary outcomes in this non-blinded study were weight and HbA1c . Patients on the LFD aim ed for 55–60 energy per cent ( E% ) and those on LCD for 20 E% from carbohydrate . Results The mean BMI and HbA1c of the participants were 32.7 ± 5.4 kg/m2 and 57.0 ± 9.2 mmol/mol , respectively . No patients were lost to follow-up . Weight loss did not differ between groups and was maximal at 6 months : LFD −3.99 ± 4.1 kg ( n = 31 ) ; LCD −4.31 ± 3.6 kg ( n = 30 ) ; p < 0.001 within groups . At 24 months , patients on the LFD had lost −2.97 ± 4.9 kg and those on LCD −2.34 ± 5.1 kg compared with baseline ( p = 0.002 and p = 0.020 within groups , respectively ) . HbA1c fell in the LCD group only ( LCD at 6 months −4.8 ± 8.3 mmol/mol , p = 0.004 , at 12 months −2.2 ± 7.7 mmol/mol , p = 0.12 ; LFD at 6 months −0.9 ± 8.8 mmol/mol , p = 0.56 ) . At 6 months , HDL-cholesterol had increased with the LCD ( from 1.13 ± 0.33 mmol/l to 1.25 ± 0.47 mmol/l , p = 0.018 ) while LDL-cholesterol did not differ between groups . Insulin doses were reduced in the LCD group ( 0 months , LCD 42 ± 65 E , LFD 39 ± 51 E ; 6 months , LCD 30 ± 47 E , LFD 38 ± 48 E ; p = 0.046 for between-group change ) . Conclusions /interpretationWeight changes did not differ between the diet groups , while insulin doses were reduced significantly more with the LCD at 6 months , when compliance was good . Thus , aim ing for 20 % of energy intake from carbohydrates is safe with respect to cardiovascular risk compared with the traditional LFD and this approach could constitute a treatment alternative . Trial registration : Clinical Trials.gov NCT01005498 Funding : University Hospital of Linköping Research Funds , Linköping University , the County Council of Östergötl and , and the Diabetes Research Centre of Linköping AIMS To compare the effects of lifestyle modification programs that prescribe low-glycemic load ( GL ) vs. low-fat diets in a r and omized trial . METHODS Seventy-nine obese adults with type 2 diabetes received low-fat or low-GL dietary instruction , delivered in 40-week lifestyle modification programs with identical goals for calorie intake and physical activity . Changes in weight , HbA(1c ) , and other metabolic parameters were compared at weeks 20 and 40 . RESULTS Weight loss did not differ between groups at week 20 ( low-fat : -5.7±3.7 % ; low-GL : -6.7±4.4 % , p=.26 ) or week 40 ( low-fat : -4.5±7.5 % ; low-GL : -6.4±8.2 % , p=.28 ) . Adjusting for changes in antidiabetic medications , subjects on the low-GL diet had larger reductions in HbA(1c ) than those on the low-fat diet at week 20 ( low-fat : -0.3±0.6 % ; low-GL : -0.7±0.6 % , p=.01 ) , and week 40 ( low-fat : -0.1±1.2 % ; low-GL : -0.8±1.3 % ; p=.01 ) . Groups did not differ significantly on any other metabolic outcomes ( p≥.06 ) . CONCLUSIONS Results suggest that targeting GL , rather than dietary fat , in a low-calorie diet can significantly enhance the effect of weight loss on HbA(1c ) in patients with type 2 diabetes BACKGROUND & AIMS The usefulness of low-carbohydrate diet ( LCD ) for Japanese patients with type 2 diabetes mellitus ( T2DM ) has not been fully investigated . Therefore , we compared the effectiveness and safety of LCD with calorie restricted diet ( CRD ) . METHODS This prospect i ve , r and omized , open-label , comparative study included 66 T2DM patients with HbA1c > 7.5 % even after receiving repeated education programs on CRD .  They were r and omly allocated to either the 130g/day LCD group ( n = 33 ) or CRD group ( n = 33 ) . Patients received personal nutrition education of CRD or LCD for 30 min at baseline , 1 , 2 , 4 , and 6 months . Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients ( 28 × ideal body weight calories per day ) . Patients of the LCD group were advised to maintain the intake of 130 g/day carbohydrate without other specific restrictions . Several parameters were assessed at baseline and 6 months after each intervention . The primary endpoint was a change in HbA1c level from baseline to the end of the study . RESULTS At baseline , BMI and HbA1c were 26.5 ( 24.6 - 30.1 ) and 8.3 ( 8.0 - 9.3 ) , and 26.7 ( 25.0 - 30.0 ) kg/m2 and 8.0 ( 7.6 - 8.9 ) % , in the CRD and LCD , respectively . At the end of the study , HbA1c decreased by -0.65 ( -1.53 to -0.10 ) % in the LCD group , compared with 0.00 ( -0.68 to 0.40 ) % in the CRD group ( p < 0.01 ) . Also , the decrease in BMI in the LCD group [ -0.58 ( -1.51 to -0.16 ) kg/m2 ] exceeded that observed in the CRD group ( p = 0.03 ) . CONCLUSIONS Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with T2DM . LCD is a potentially useful nutrition therapy for Japanese patients who can not adhere to CRD . This trial was registered at http://www.umin.ac.jp/english/ ( University Hospital Medical Information Network : study ID number 000010663 ) BACKGROUND The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus ( DM2 ) is unclear . Trials comparing the effectiveness of diets are frequently limited by short follow-up times and high dropout rates . AIM The effects of a low carbohydrate Mediterranean ( LCM ) , a traditional Mediterranean ( TM ) , and the 2003 American Diabetic Association ( ADA ) diet were compared , on health parameters during a 12-month period . METHODS In this 12-month trial , 259 overweight diabetic patients ( mean age 55 years , mean body mass index 31.4 kg/m(2 ) ) were r and omly assigned to one of the three diets . The primary end-points were reduction of fasting plasma glucose , HbA1c and triglyceride ( TG ) levels . RESULTS 194 patients out of 259 ( 74.9 % ) completed follow-up . After 12 months , the mean weight loss for all patients was 8.3 kg : 7.7 kg for ADA , 7.4 kg for TM and 10.1 kg for LCM diets . The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet ( -2.0 and -1.6 % , respectively , p < 0.022 ) . HDL cholesterol increased ( 0.1 mmol/l + /- 0.02 ) only on the LCM ( p < 0.002 ) . The reduction in serum TG was greater in the LCM ( -1.3 mmol/l ) and TM ( -1.5 mmol/l ) than in the ADA ( -0.7 mmol/l ) , p = 0.001 . CONCLUSIONS An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups . Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control BACKGROUND The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed . METHODS We r and omly assigned 132 severely obese subjects ( including 77 blacks and 23 women ) with a mean body-mass index of 43 and a high prevalence of diabetes ( 39 percent ) or the metabolic syndrome ( 43 percent ) to a carbohydrate-restricted ( low-carbohydrate ) diet or  a calorie- and fat-restricted ( low-fat ) diet . RESULTS Seventy-nine subjects completed the six-month study . An analysis including all subjects , with the last observation carried forward for those who dropped out , showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet ( mean [ + /-SD ] , -5.8+/-8.6 kg vs. -1.9+/-4.2 kg ; P=0.002 ) and had greater decreases in triglyceride levels ( mean , -20+/-43 percent vs. -4+/-31 percent ; P=0.001 ) , irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications . Insulin sensitivity , measured only in subjects without diabetes , also improved more among subjects on the low-carbohydrate diet ( 6+/-9 percent vs. -3+/-8 percent , P=0.01 ) . The amount of weight lost ( P<0.001 ) and assignment to the low-carbohydrate diet ( P=0.01 ) were independent predictors of improvement in triglyceride levels and insulin sensitivity . CONCLUSIONS Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet , with a relative improvement in insulin sensitivity and triglyceride levels , even after adjustment for the amount of weight lost . This finding should be interpreted with caution , given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study . Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed BACKGROUND In the United States , obesity is a major clinical and public health problem causing diabetes , dyslipidemia , and hypertension , as well as increasing cardiovascular and total mortality . Dietary restrictions of calories and saturated fat are beneficial . However , it remains unclear whether replacement of saturated fat with carbohydrates ( as in the US National Cholesterol Education Program [ NCEP ] diet ) or protein and monounsaturated fat ( as in our isocaloric modified low-carbohydrate [ MLC ] diet , which is lower in total carbohydrates but higher in protein , monounsaturated fat , and complex carbohydrates ) is optimal . METHODS We r and omized 60 participants ( 29 women and 31 men ) to the NCEP or the MLC diet  and evaluated them every 2 weeks for 12 weeks . They were aged 28 to 71 years ( mean age , 44 years in the NCEP and 46 years in the MLC group ) . A total of 36 % of participants from the NCEP group and 35 % from the MLC group had a body mass index ( calculated as weight in kilograms divided by the square of height in meters ) greater than 27 . The primary end point was weight loss , and secondary end points were blood lipid levels and waist-to-hip ratio . RESULTS Weight loss was significantly greater in the MLC ( 13.6 lb ) than in the NCEP group ( 7.5 lb ) , a difference of 6.1 lb ( P = .02 ) . There were no significant differences between the groups for total , low density , and high-density lipoprotein cholesterol , triglycerides , or the proportion of small , dense low-density lipoprotein particles . There were significantly favorable changes in all lipid levels within the MLC but not within the NCEP group . Waist-to-hip ratio was not significantly reduced between the groups ( P = .27 ) , but it significantly decreased within the MLC group ( P = .009 ) . CONCLUSIONS Compared with the NCEP diet , the MLC diet , which is lower in total carbohydrates but higher in complex carbohydrates , protein , and monounsaturated fat , caused significantly greater weight loss over 12 weeks . There were no significant differences between the groups in blood lipid levels , but favorable changes were observed within the MLC diet group OBJECTIVE —The purpose of this study was to compare the effects of high – monounsaturated fatty acid ( MUFA ) and high-carbohydrate ( CHO ) diets on body weight and glycemic control in men and women with type 2 diabetes . RESEARCH DESIGN AND METHODS —Overweight/obese participants with type 2 diabetes ( n = 124 , age = 56.5 ± 0.8 years , BMI = 35.9 ± 0.3 kg/m2 , and A1C = 7.3 ± 0.1 % ) were r and omly assigned to 1 year of a high-MUFA or high-CHO diet . Anthropometric and metabolic parameters were assessed at baseline and after 4 , 8 , and 12 months of dieting . RESULTS —Baseline characteristics were similar between the treatment groups . The overall retention rate for 1 year was 77 % ( 69 % for the high-MUFA group and 84 % for the high-CHO group ; P = 0.06 ) . Based on food records , both groups had similar energy intake but a significant difference in MUFA intake . Both groups had similar weight loss over 1 year ( −4.0 ± 0.8 vs. −3.8 ± 0.6 kg ) and comparable improvement in body fat , waist circumference , diastolic blood pressure , HDL cholesterol , A1C , and fasting glucose and insulin . There were no differences in these parameters between the groups . A follow-up assessment of a subset of participants ( n = 36 ) was conducted 18 months after completion of the 52-week diet . These participants maintained their weight loss and A1C during the follow-up period . CONCLUSIONS —In individuals with type 2 diabetes  , high-MUFA diets are an alternative to conventional lower-fat , high-CHO diets with comparable beneficial effects on body weight , body composition , cardiovascular risk factors , and glycemic control BACKGROUND & AIMS We determined the effects of acute and chronic calorie restriction with either a low-fat , high-carbohydrate ( HC ) diet or a low-carbohydrate ( LC ) diet on hepatic and skeletal muscle insulin sensitivity . METHODS Twenty-two obese subjects ( body mass index , 36.5 + /- 0.8 kg/m2 ) were r and omized to an HC ( > 180 g/day ) or LC ( < 50 g/day ) energy-deficit diet . A euglycemic-hyperinsulinemic clamp , muscle biopsy specimens , and magnetic resonance spectroscopy were used to determine insulin action , cellular insulin signaling , and intrahepatic triglyceride ( IHTG ) content before , after 48 hours , and after approximately 11 weeks ( 7 % weight loss ) of diet therapy . RESULTS At 48 hours , IHTG content decreased more in the LC than the HC diet group ( 29.6 % + /- 4.8 % vs 8.9 % + /- 1.4 % ; P < .05 ) but was similar in both groups after 7 % weight loss ( LC diet , 38.0 % + /- 4.5 % ; HC diet , 44.5 % + /- 13.5 % ) . Basal glucose production rate decreased more in the LC than the HC diet group at 48 hours ( 23.4 % + /- 2.2 % vs 7.2 % + /- 1.4 % ; P < .05 ) and after 7 % weight loss ( 20.0 % + /- 2.4 % vs 7.9 % + /- 1.2 % ; P < .05 ) . Insulin-mediated glucose uptake did not change at 48 hours but increased similarly in both groups after 7 % weight loss ( 48.4 % + /- 14.3 % ; P < .05 ) . In both groups , insulin-stimulated phosphorylation of c-Jun-N-terminal kinase decreased by 29 % + /- 13 % and phosphorylation of Akt and insulin receptor substrate 1 increased by 35 % + /- 9 % and 36 % + /- 9 % , respectively , after 7 % weight loss ( all P < .05 ) . CONCLUSIONS Moderate calorie restriction causes temporal changes in liver and skeletal muscle metabolism ; 48 hours of calorie restriction affects the liver ( IHTG content , hepatic insulin sensitivity , and glucose production ) , whereas moderate weight loss affects muscle ( insulin-mediated glucose uptake and insulin signaling ) Background We assessed the long-term effects of a Mediterranean diet on circulating levels of endothelial progenitor cells ( EPCs ) and the carotid intima-media thickness ( CIMT ) in patients with type 2 diabetes . Design This was a parallel , two-arm , single-centre trial . Methods Two hundred and fifteen men and women with newly diagnosed type 2 diabetes were r and omized to a Mediterranean diet ( n = 108 ) or a low-fat diet ( n = 107 ) . The primary outcome measures were changes in the EPC count and the CIMT of the common carotid artery after the treatment period defined as the end of trial ( EOT ) . Results At the EOT , both the CD34+KDR+ and CD34+KDR+CD133 + counts had increased with the Mediterranean diet compared with the low-fat diet ( p < 0.05 for both ) . At the EOT evaluation , there was a significant ( p = 0.024 ) difference of −0.025 mm in the CIMT favouring the Mediterranean diet . Compared with the low-fat diet , the rate of regression in the CIMT was higher in the Mediterranean diet group ( 51 vs. 26 % ) , whereas the rate of progression was lower ( 25 vs. 50 % ) ( p = 0.032 for both ) . Changes in the CIMT were inversely correlated with the changes in EPC levels ( CD34+KDR+ , r = −0.24 , p = 0.020 ; CD34+KDR+CD133 + , r = −0.28 , p = 0.014 ) . At the EOT , changes in levels of HbA1c , HOMA , total cholesterol , high-density lipoprotein cholesterol and systolic blood pressure were significantly greater with the Mediterranean diet than with the low-fat diet . Conclusion Compared with a low-fat diet , a long-term trial with Mediterranean diet was associated with an increase in circulating EPCs levels and prevention of the progression of sub clinical atherosclerosis in patients with newly diagnosed type 2 diabetes Abstract Purpose To test the effect of three diets in their ability to sustain weight loss and improve type 2 diabetes ( T2D ) and cardiovascular disease ( CVD ) risk markers after 18-month intervention . Methods Following a ≥8 % weight loss , 131 healthy , overweight/obese ( BMI ± SD 31.5 ± 2.6 kg/m2 ) men ( n = 55 ) and women ( n = 76 ) aged 28.2 ± 4.8 years were r and omized to either 1 . Moderate fat ( 40 E% ) with 20 E% MUFA and low in glycemic index ( GI ) ( MUFA , n = 54 ) , 2 . Low fat ( 25 E% ) and medium in GI ( LF , n = 51 ) or 3 . Control ( 35 E% fat ) and high in GI ( CTR , n = 26 ) all with similar protein content , and all provided ad libitum . First 6-month intervention with 100 % food provision ( previously reported ) following 12 months of moderately intensive intervention with 20 % food provision now reported . Results Attrition rate was higher in MUFA ( 63 % ) than in LF ( 37 % , P = 0.019 ) and CTR ( 42 % , P = 0.09 ) group . Weight regain in completers was not different between groups ( mean ± SEM ) , MUFA 7.1 ± 2.1 % versus LF 5.6 ± 1.3 % versus CTR 7.2 ± 1.5 % , nor was body fat regain , MUFA 4.8 ± 1.0 % versus LF 4.7 ± 0.8 % versus CTR 5.7 ± 0.6 % . The MUFA group reduced LDL/HDL ratio by −0.47 ± 0.09 compared with −0.23 ± 0.11 in LF ( P < 0.05 ) and 0.06 ± 0.14 ( P < 0.005 ) in CTR groups . Conclusions Weight regain or body composition did not differ between diets over 18 months . No effects on risk markers for T2D or CVD were found , with the exception of an improvement in the LDL/HDL ratio by the MUFA diet compared to the CTR diet . The LF diet was generally more satisfactory and the MUFA diet seemed more difficult to follow Background Type 2 diabetes is a prevalent , chronic disease for which diet is an integral aspect of treatment . In our previous trial , we found that recommendations to follow a very low-carbohydrate ketogenic diet and to change lifestyle factors ( physical activity , sleep , positive affect , mindfulness ) helped overweight people with type 2 diabetes or prediabetes  improve glycemic control and lose weight . This was an in-person intervention , which could be a barrier for people without the time , flexibility , transportation , social support , and /or financial re sources to attend . Objective The aim was to determine whether an online intervention based on our previous recommendations ( an ad libitum very low-carbohydrate ketogenic diet with lifestyle factors ; “ intervention ” ) or an online diet program based on the American Diabetes Associations ’ “ Create Your Plate ” diet ( “ control ” ) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes . Methods In this pilot feasibility study , we r and omized overweight adults ( body mass index ≥25 ) with type 2 diabetes ( glycated hemoglobin [ HbA1c ] 6.5%-9.0 % ) to a 32-week online intervention based on our previous recommendations ( n=12 ) or an online diet program based around a plate method diet ( n=13 ) to assess the impact of each intervention on glycemic control and other health outcomes . Primary and secondary outcomes were analyzed by mixed-effects linear regression to compare outcomes by group . Results At 32 weeks , participants in the intervention group reduced their HbA1c levels more ( estimated marginal mean [ EMM ] –0.8 % , 95 % CI –1.1 % to –0.6 % ) than participants in the control group ( EMM –0.3 % , 95 % CI –0.6 % to 0.0 % ; P=.002 ) . More than half of the participants in the intervention group ( 6/11 , 55 % ) lowered their HbA1c to less than 6.5 % versus 0 % ( 0/8 ) in the control group ( P=.02 ) . Participants in the intervention group lost more weight ( EMM –12.7 kg , 95 % CI –16.1 to –9.2 kg ) than participants in the control group ( EMM –3.0 kg , 95 % CI –7.3 to 1.3 kg ; P<.001 ) . A greater percentage of participants lost at least 5 % of their body weight in the intervention ( 10/11 , 90 % ) versus the control group ( 2/8 , 29 % ; P=.01 ) . Participants in the intervention group lowered their triglyceride levels ( EMM –60.1 mg/dL , 95 % CI –91.3 to –28.9 mg/dL ) more than participants in the control group ( EMM –6.2 mg/dL , 95 % CI –46.0 to 33.6 mg/dL ; P=.01 ) . Dropout was 8 % ( 1/12 ) and 46 % ( 6/13 ) for the intervention and control groups , respectively ( P=.07 ) . Conclusions Individuals with type 2 diabetes improved their glycemic control and lost more weight after being r and omized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional , low-fat diabetes diet online program . Thus , the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes . Trial Registration Clinical Trials.gov NCT01967992 ; https:// clinical trials.gov/ct2/show/NCT01967992 ( Archived by WebCite at http://www.webcitation.org/6o0fI9Mkq BACKGROUND In single-meal studies , dietary protein does not result in an increase in glucose concentrations in persons with or without type 2 diabetes , even though the result ing amino acids can be used for gluconeogenesis . OBJECTIVE The metabolic effects of a high-protein diet were compared with those of the prototypical healthy ( control ) diet , which is currently recommended by several scientific organizations . DESIGN The metabolic effects of both diets , consumed for 5 wk each ( separated by a 2 - 5-wk washout period ) , were studied in 12 subjects with untreated type 2 diabetes . The ratio of protein to carbohydrate to fat was 30:40:30 in the high-protein diet and 15:55:30 in the control diet . The subjects remained weight-stable during the study . RESULTS With the fasting glucose concentration used as a baseline from which to determine the area under the curve , the high-protein diet result ed in a 40 % decrease in the mean 24-h integrated glucose area response . Glycated hemoglobin decreased 0.8 % and 0.3 % after 5 wk of the high-protein and control diets , respectively ; the difference was significant ( P < 0.05 ) . The rate of change over time was also significantly greater after the high-protein diet than after the control diet ( P < 0.001 ) . Fasting triacylglycerol was significantly lower after the high-protein diet than after the control diet . Insulin , C-peptide , and free fatty acid concentrations were not significantly different after the 2 diets . CONCLUSION A high-protein diet lowers blood glucose postpr and ially in persons with type 2 diabetes and improves overall glucose control . However , longer-term studies are necessary to determine the total magnitude of response , possible adverse effects , and the long-term acceptability of the diet To determine the mechanisms of increase in plasma triacylglycerol concentrations after high dietary intakes of carbohydrates , 10 men with non-insulin-dependent diabetes mellitus ( NIDDM ) were fed an isoenergetic high-carbohydrate diet ( 55 % of energy as carbohydrate and 30 % as fat ) and a high-monounsaturated-fat diet ( 45 % of energy as fat and 40 % as carbohydrates ) for 6 wk in a r and omized , crossover manner . The high-carbohydrate diet raised fasting plasma triacylglycerol concentrations by 26 % ( P = 0.007 ) but did not affect postheparin lipoprotein lipase ( P = 0.2 ) or hepatic lipase activities ( P = 0.9 ) . The oral-fat-tolerance test labeled with retinyl palmitate also revealed no differences in postpr and ial plasma triacylglycerol ( P = 0.37 ) or retinyl palmitate clearances ( P = 0.34 ) between the two diets . We conclude that the increase in plasma triacylglycerol concentrations with high-carbohydrate diets in men with NIDDM is not due to reduced lipolysis or diminished postpr and ial clearance of triacylglycerol-rich lipoproteins but is primarily due to increased hepatic secretion of very-low-density-lipoprotein triacylglycerols BACKGROUND The optimal source and amount of dietary carbohydrate for managing type 2 diabetes ( T2DM ) are unknown . OBJECTIVE We aim ed 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 r and omly 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 postpr and ial glucose and CRP , a low-GI diet may be preferred for the dietary management of T2DM BACKGROUND An important therapeutic goal for patients with type 2 diabetes is weight loss , which improves metabolic abnormalities . Ad libitum low-fat diets cause weight loss in nondiabetic population s. Compared with diets higher in monounsaturated fat , however , eucaloric low-fat diets may increase plasma triacylglycerol concentrations and worsen glycemic control in persons with type 2 diabetes . OBJECTIVE We investigated whether , in type 2 diabetes patients , an ad libitum low-fat diet would cause greater weight loss than would a high-monounsaturated fat diet and would do this without increasing plasma triacylglycerol concentrations or worsening glycemic control . DESIGN Eleven patients with type 2 diabetes were r and omly assigned to receive an ad libitum low-fat , high-carbohydrate diet or a high-monounsaturated fat diet , each for 6 wk . The diets offered contained 125 % of the estimated energy requirement to allow self- selection of food quantity . The response variables were body weight ; fasting plasma lipid , lipoprotein , glucose , glycated hemoglobin A(1c ) , and fructosamine concentrations ; insulin sensitivity ; and glucose disposal . RESULTS Body weight decreased significantly ( 1.53 kg ; P < 0.001 ) only with the low-fat diet .  Plasma total , LDL- , and HDL-cholesterol concentrations tended to decrease during both diets . There were no interaction effects between diet and the lipid profile response over time . Plasma triacylglycerol concentrations , glycemic control , and insulin sensitivity did not differ significantly between the 2 diets . CONCLUSION Contrary to expectations , the ad libitum , low-fat , high-fiber diet promoted weight loss in patients with type 2 diabetes without causing unfavorable alterations in plasma lipids or glycemic control Two groups of patients with non-insulin-dependent diabetes mellitus ( NIDDM ) , with dietary advice r  and  omized between a low-carbohydrate ( LC ) diet and a modified-fat ( MF ) diet , were followed to determine the effect of diet on phospholipid fatty acid composition of platelets and on development of retinopathy in the 7 years following diagnosis . There was a tendency for retinopathy to occur more frequently in those r and omized to the LC diet . This difference was not statistically significant , and fatty acid composition of platelets did not differ significantly in those with and without retinopathy . Linoleic acid values from platelet phospholipid fatty acids were significantly higher in NIDDM on an MF diet compared with an LC diet . There was no difference between the two dietary subgroups with respect to platelet arachidonic acid , but this was lower in the whole diabetic population when compared with non-diabetics . The arachidonic acid values correlated with neither glycosylated haemoglobin nor mean glycaemia . Significant correlation between the fatty acid values for platelets and plasma cholesterol esters was found only for 16:0 Brackground : The safety and tolerability of very low-calorie-ketogenic ( VLCK ) diets are a current concern in the treatment of obese type 2 diabetes mellitus ( T2DM ) patients . Objective : Evaluating the short-term safety and tolerability of a VLCK diet ( < 50 g of carbohydrate daily ) in an interventional weight loss program including lifestyle and behavioral modification support ( Diaprokal Method ) in subjects with T2DM . Methods : Eighty-nine men and women , aged between 30 and 65 years , with T2DM and body mass index between 30 and 35 kg m−2 participated in this prospect i ve , open-label , multi-centric r and omized clinical trial with a duration of 4 months . Forty-five subjects were r and omly assigned to the interventional weight loss ( VLCK diet ) , and 44 to the st and ard low-calorie diet . Results : No significant differences in the laboratory safety parameters were found between the two study groups . Changes in the urine albumin-to-creatinine ratio in VLCK diet were not significant and were comparable to control group . Creatinine and blood urea nitrogen did not change significantly relative to baseline nor between groups . Weight loss and reduction in waist circumference in the VLCK diet group were significantly larger than in control subjects ( both P<0.001 ) . The decline in HbA1c and glycemic control was larger in the VLCK diet group ( P<0.05 ) . No serious adverse events were reported and mild AE in the VLCK diet group declined at last follow-up . Conclusions : The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a st and ard hypocaloric diet with safety and good tolerance for T2DM patients To compare blood pressure , glucose and fat metabolism after a high-fat diet rich in monounsaturated fat reduced day time systolic ( 131 + /- 3 vs. 137 + /- 3 mmHg , p < 0.04 ) and 24-hour systolic blood pressure ( 126 + /- 8 vs. 130 + /- 10 mmHg , p < 0.03 ) as well as day time diastolic ( 78 + /- 2 vs. 84 + /- 52 mmHg , p < 0.02 ) and diurnal diastolic blood pressure ( 75 + /- 6 vs. 78 + /- 5 mmHg , p < 0.03 ) as compared with the high-carbohydrate diet . Evidence of improved glucose tolerance on the high-monounsaturated diet compared with the high-carbohydrate diet were found with lower fasting blood glucose ( 6.1 + /- 0.3 vs. 6.8 + /- 0.5 mM , p < 0.05 ) , lower average blood glucose levels ( 7.4 + /- 0.5 vs. 8.2 + /- 0.6 mmol/l , p < 0.01 ) and peak blood glucose responses ( 9.9 + /- 0.6 vs. 11.3 + /- 0.7 mmol/l , p < 0.02 ) . Similar levels of fasting triglyceride , total cholesterol , LDL- and HDL cholesterol were found after the two diets OBJECTIVE Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance , many patients are unable to comply with such dietary therapy for long periods . The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association . However , r and omised trials of dietary interventions in Japanese patients with type 2 diabetes are scarce . Therefore , the aim of this study was to examine the effects of a non-calorie-restricted , low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet . METHODS The enrolled patients were r and omly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet . The patients received consultations every two months from a registered dietician for six months . We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles . RESULTS The HbA1c levels decreased significantly from baseline to six months in the low-carbohydrate diet group ( baseline 7.6±0.4 % , six months 7.0±0.7 % , p=0.03 ) but not in the calorie-restricted group ( baseline 7.7±0.6 % , six months 7.5±1.0 % , n.s . ) , ( between-group comparison , p=0.03 ) . The patients in the former group also experienced improvements in their triglyceride levels , without experiencing any major adverse effects or a decline in the quality of life . CONCLUSION Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet BACKGROUND Glucose-dependent insulinotropic polypeptide [ also known as gastric inhibitory polypeptide ( GIP ) ] and its receptor ( GIPR ) may link overnutrition to obesity , insulin resistance , and type 2 diabetes . A GIPR variant rs2287019 was recently associated with obesity and glucose metabolism . OBJECTIVE We aim ed to examine whether weight-loss diets that vary in fat content may modify the effect of this variant on changes in body weight , fasting glucose , and insulin resistance in the Preventing Overweight Using Novel Dietary Strategies ( POUNDS LOST ) trial . DESIGN We genotyped the GIPR rs2287019 in 737 overweight adults who were r and omly assigned to 1 of 4 weight-loss diets that varied in macronutrient contents for 2 y. We assessed the percentage changes in body weight , fasting glucose , and insulin resistance ( HOMA-IR ) across genotypes by the low-fat and high-fat diets . RESULTS At 6 mo of diet intervention , the T allele of rs2287019 was associated with greater weight loss ( β ± SE : -1.05 ± 0.56 % ; P = 0.06 ) and greater decreases in fasting glucose ( β ± SE : -2.33 ± 0.86 % ; P = 0.006 ) , fasting insulin ( β ± SE : -8.76 ± 4.13 % ; P = 0.03 ) , and HOMA-IR ( β ± SE : -10.52 ± 4.39 % ; P = 0.01 ) in participants who were assigned to low-fat diets , whereas there was no significant genotype effect on changes in these traits in the group assigned to the high-fat diet ( all P > 0.44 ; P-interaction = 0.08 , 0.04 , 0.10 , and 0.07 , respectively ) . After correction for multiple tests ( significant P = 0.008 ) , the genotype effect on changes in fasting glucose remained significant . Sensitivity analysis in white participants showed that the interactions were more evident on changes in insulin and HOMA-IR ( P-interaction < 0.008 ) . CONCLUSION The T allele of GIPR rs2287019 is associated with greater improvement of glucose homeostasis in individuals who choose a low-fat , high-carbohydrate , and high-fiber diet . The POUNDS LOST trial was registered at clinical trials.gov as NCT00072995 Abstract Aims /hypothesisThe aim of the study was to determine whether basal insulin resistance ( IR ) phenotype ( muscle and /or liver ) determines the effect of long-term consumption of a Mediterranean diet or a low-fat diet on tissue-specific IR and beta cell function . Methods The study was performed in 642 patients included in The effect of an olive oil rich Mediterranean diet on type 2 diabetes mellitus risk and incidence study ( CORDIOPREV-DIAB ) . A total of 327 patients were r and omised to a Mediterranean diet ( 35 % fat ; 22 % from monounsaturated fatty acids ) and 315 to a low-fat diet ( < 28 % fat ) . At baseline , the patients were classified into four phenotypes according to the type of IR : ( 1 ) no IR ; ( 2 ) muscle IR ; ( 3 ) liver IR ; ( 4 ) muscle + liver IR . The hepatic insulin resistance index ( HIRI ) , muscular insulin sensitivity index ( MISI ) and disposition index were analysed at baseline and after 2 years of follow-up . Results At baseline , 322 patients presented  no IR , 106 presented muscle IR , 109 presented liver IR , and 105 presented muscle + liver IR . With both dietary interventions , HIRI decreased in all patients ( p < 0.001 ) and MISI increased in muscle IR and muscle + liver IR patients ( p < 0.01 ) . Long-term intake of the Mediterranean diet increased the disposition index and insulinogenic index in the muscle IR patients ( p = 0.042 and p = 0.044 , respectively ) and the disposition index in the muscle + liver IR patients ( p = 0.048 ) , whereas the low-fat diet increased the disposition index in the liver IR patients ( p = 0.017 ) . Conclusions /interpretationAlthough both diets improve insulin sensitivity , there are differences based on basal IR phenotypes . Moreover , according to insulinogenic and disposition index data , a low-fat diet might be more beneficial to patients with liver IR , whereas patients with muscle IR and muscle + liver IR might benefit more from a Mediterranean diet . Trial registration Clinical Trials.gov NCT00924937 Funding The study was supported by the Ministerio de Economia y Competitividad ( AGL2012/39615 ) and by the Ministerio de Ciencia e Innovacion ( PIE14/00005 and PI13/00023 OBJECTIVE To assess the long-term effects of dietary interventions on glycemic control , need for diabetes medications , and remission of type 2 diabetes . RESEARCH DESIGN AND METHODS Originally , in a two-arm trial design , overweight , middle-aged men and women with newly diagnosed type 2 diabetes were r and omized to a low-carbohydrate Mediterranean diet ( LCMD ; n = 108 ) or a low-fat diet ( n = 107 ) . After 4 years , participants who were still free of diabetes medications were further followed up until the primary end point ( need of a diabetic drug ) ; remission of diabetes ( partial or complete ) and changes in weight , glycemic control , and cardiovascular risk factors were also evaluated . RESULTS The primary end point was reached in all participants after a total follow-up of 6.1 years in the low-fat group and 8.1 years in the LCMD group ; median survival time was 2.8 years ( 95 % CI 2.4–3.2 ) and 4.8 years ( 4.3–5.2 ) , respectively . The unadjusted hazard ratio for the overall follow-up was 0.68 ( 0.50–0.89 ; P < 0.001 ) . LCMD participants were more likely to experience any remission ( partial or complete ) , with a prevalence of 14.7 % ( 13.0–16.5 % ) during the first year and 5.0 % ( 4.4–5.6 % ) during year 6 compared with 4.1 % ( 3.1–5.0 % ) at year 1 and 0 % at year 6 in the low-fat diet group . CONCLUSIONS In patients with newly diagnosed type 2 diabetes , an LCMD result ed in a greater reduction of HbA1c levels , higher rate of diabetes remission , and delayed need for diabetes medication compared with a low-fat diet OBJECTIVE To determine whether the lipoprotein response to weight loss in obese patients with type 2 diabetes can be improved by modifying the macronutrient composition of the commonly prescribed low-fat , high-carbohydrate ( CHO ) hypocaloric diet . RESEARCH DESIGN AND METHODS Nine obese patients with type 2 diabetes were treated with a monounsaturated fatty acid (MUFA)-enriched weight-reducing formula diet and compared with eight obese patients with type 2 diabetes treated with a low-fat , high-CHO weight-reducing formula diet .  Weight loss ensued for 6 weeks , followed by 4 weeks of refeeding using isocaloric formulas enriched with MUFA or CHO , respectively . Fasting blood sample s were obtained to measure plasma lipoproteins and LDL susceptibility to oxidation ( measured as lag time : time required to induce in vitro formation of conjugated dienes ) . RESULTS At baseline , there were no differences between the groups in plasma lipids , lipoproteins , or LDL susceptibility to oxidation . Weight loss was similar between the groups . Dieting result ed in decreases in total plasma cholesterol , LDL , HDL , triglycerides , and apolipoproteins A and B ( P < 0.05 ) , but the MUFA group manifested a greater decrease in total cholesterol , triglycerides , and apolipoprotein B and a smaller decrease in HDL and apolipoprotein A than the CHO group ( P < 0.05 ) . Improvements in these parameters were sustained during refeeding . After dieting , lag time was prolonged in the MUFA group ( 208 ± 10 min ) compared with the CHO group ( 146 ± 11 min ; P < 0.05 ) . Lag time was prolonged further during refeeding in the MUFA group ( 221 ± 13 min , P = 0.10 ) , while the CHO group remained unchanged ( 152 ± 9 min , P < 0.05 ) . Lag time correlated strongly with the oleic acid content of LDL after dieting and refeeding ( r = 0.74 and r = 0.93 , respectively ; both P < 0.001 ) . CONCLUSIONS Macronutrient content is an important determinant of the lipoprotein response to weight loss in obese patients with type 2 diabetes . MUFA-enriched hypocaloric diets potentiate the beneficial effects of weight loss to ameliorate cardiovascular risk factors in obese patients with type 2 diabetes BACKGROUND Current dietary guidelines recommend the replacement of saturated fatty acids ( SAFAs ) with carbohydrates or monounsaturated fatty acids ( MUFAs ) based on evidence on lipid profile alone , the chronic effects of the mentioned replacements on insulin secretion and insulin sensitivity are however unclear . OBJECTIVE To assess the chronic effects of the substitution of refined carbohydrate or MUFA for SAFA on insulin secretion and insulin sensitivity in central ly obese subjects . METHODS Using a crossover design , r and omized controlled trial in abdominally overweight men and women , we compared the effects of substitution of 7 % energy as carbohydrate or MUFA for SAFA for a period of 6 weeks each . Fasting and postpr and ial blood sample s in response to corresponding SAFA , carbohydrate , or MUFA-enriched meal-challenges were collected after 6 weeks on each diet treatment for the assessment of outcomes . RESULTS As expected , postpr and ial nonesterified fatty acid suppression and elevation of C-peptide , insulin and glucose secretion were the greatest with high-carbohydrate ( CARB ) meal . Interestingly , CARB meal attenuated postpr and ial insulin secretion corrected for glucose response ; however , the insulin sensitivity and disposition index were not affected . SAFA and MUFA had similar effects on all markers except for fasting glucose-dependent insulinotropic peptide concentrations , which increased after MUFA but not SAFA when compared with CARB . CONCLUSION In conclusion , a 6-week lower-fat/higher-carbohydrate ( increased by 7 % refined carbohydrate ) diet may have greater adverse effect on insulin secretion corrected for glucose compared with isocaloric higher-fat diets . In contrast , exchanging MUFA for SAFA at 7 % energy had no appreciable adverse impact on insulin secretion Objective : To compare effects of a high carbohydrate ( high-CHO ) and a monounsaturated fat diet ( high-MUFA ) on body fat distribution and sex hormones in post-menopausal women with Type 2 diabetes . Design : R and omised cross-over with no washout . Setting : Geelong Hospital outpatient . Subjects : Thirty four women were recruited , 30 completed the study , and data are presented for 21 women compliant to the high-CHO diet . Interventions : Women followed a high-CHO diet ( 20 % energy ( % E ) from fat , 60%E from carbohydrate and a high-MUFA diet ( 40%E from fat , half as monounsaturated fat , 40%E from carbohydrate ) in r and om order for 12 weeks each . Main outcome measures : Dietary compliance was measured by change in linoleic acid ( C18:2 , ω-6 ) in plasma cholesteryl esters . Body composition was measured by dual-energy X-ray absorptiometry . Fasting concentrations of glucose and insulin were measured in plasma . Steroid hormones and sex hormone binding globulin ( SHBG ) were measured in serum . Results : On the high-CHO diet C18:2 , ω-6 in plasma cholesteryl esters declined by 5.4 % ( 95 % confidence intervals ( CI ) , −2.5 % to −8.4 % , P=0.0015 ) . Fat was lost mainly from the lower body ( lower body loss −0.71 kg , 95 % CI , −0.43 to −1.00 kg , P=0.001 ; upper body loss −0.15 kg , 95 % CI , −0.76 to + 0.46 kg , P=0.6 ) . Yet on the high-MUFA  diet , lower body fat loss was minimal ( −0.22 kg , 95%CI , + 0.11 to −0.55 kg , P=0.2 ) . By general linear modelling ( GLM ) , differences in lower body fat loss were significantly related to diet ( P=0.04 ) . After adjustment for age , dehydroepi and rosterone sulphate ( DHEAS ) concentrations after the high-CHO diet were related to levels of lower body fat ( r=0.394 , P=0.04 ) . Conclusions : In women with Type 2 diabetes following a high-CHO diet for 12 weeks the disproportionate loss of lower body fat is related to a decline in DHEAS.Sponsorship : Supported by grant 950921 from the National Health and Medical Research Council of Australia Objective : High-carbohydrate (HC)–high-fibre diets are recommended for weight loss and for treating and preventing diseases such as diabetes and cardiovascular disease . We report a r and omised trial comparing high-fat ( HF ) and high-protein ( HP ) diets with the conventional approach . Research design and methods : A total of 93 overweight insulin-resistant women received advice following r and omisation to HF , HP or HC dietary regimes , to achieve weight loss followed by weight maintenance over 12 months . Weight , body composition and measures of carbohydrate and lipid metabolism were investigated . Results : Retention rates were 93 % for HP and 75 % for HC and HF .  Features of the metabolic syndrome improved in all groups during the first 6 months , to a greater extent on HF and HP than an HC . During the second 6 months the HF group had increases in waist circumference ( mean difference 4.4 cm ( 95 % CI 3.0 , 5.8 ) ) , fat mass ( 2.3 kg ( 1.5 , 3.1 ) ) , triglycerides ( 0.28 mmol/l ( 0.09 , 0.46 ) ) and 2 h glucose ( 0.70 mmol/l ( 0.22 , 1.18 ) ) . Overall there was substantial sustained improvement in waist circumference , triglycerides and insulin in the HP group and sustained but more modest changes on HC .  Dietary compliance at 12 months was poor in all groups . Conclusions : HP and HC approaches appear to be appropriate options for insulin-resistant individuals . When recommending HP diets appropriate composition of dietary fat must be ensured . HC diet recommendations must include advice regarding appropriate high-fibre , low glycaemic index foods The adequate composition of carbohydrate and fat in low calorie diets for type 2 diabetes mellitus patients with obesity is not fully established . The aim of this study was to investigate the effects of low carbohydrate diet on glucose and lipid metabolism , especially on visceral fat accumulation , and comparing that of a high carbohydrate diet .  Obese subjects with type 2 diabetes mellitus were r and omly assigned to take a low calorie and low carbohydrate diet ( n = 11 , 1000 kcal per day , protein : carbohydrate : fat = 25:40:35 ) or a low calorie and high carbohydrate diet ( n = 11 , 1000 kcal per day , protein : carbohydrate : fat = 25:65:10 ) for 4 weeks . Similar decreases in body weight and serum glucose levels were observed in both groups . Fasting serum insulin levels were reduced in the low carbohydrate diet group compared to the high carbohydrate diet group ( -30 % versus -10 % , P < 0.05 ) . Total serum cholesterol and triglyceride levels decreased in both groups , but were not significantly different from each other . High-density lipoprotein-cholesterol ( HDL-C ) increased in the low carbohydrate diet group but not in the high carbohydrate diet group ( + 15 % versus 0 % , P < 0.01 ) . There was a larger decrease in visceral fat area measured by computed tomography in the low carbohydrate diet group compared to the high carbohydrate diet group ( -40 cm(2 ) versus -10 cm(2 ) , P < 0.05 ) . The ratio of visceral fat area to subcutaneous fat area did not change in the high carbohydrate diet group ( from 0.70 to 0.68 ) , but it decreased significantly in the low carbohydrate diet group ( from 0.69 to 0.47 , P < 0.005 ) . These results suggest that , when restrict diet was made isocaloric , a low calorie/low carbohydrate diet might be more effective treatment for a reduction of visceral fat , improved insulin sensitivity and increased in HDL-C levels than low calorie/high carbohydrate diet in obese subjects with type 2 diabetes mellitus OBJECTIVE To compare three sets of dietary guidelines for the treatment of non-insulin-dependent diabetes ( NIDDM ) in free-living individuals and to observe the effects on metabolic control over an 18-month period . RESEARCH DESIGN AND METHODS Seventy volunteer subjects with NIDDM were r and omly assigned to one of three diets , a weight-management diet , a high-carbohydrate/fiber diet , or a modified-lipid diet and followed for 18 months . Nutrient intakes , weight , blood lipids , and glycemic control were measured . RESULTS In all diet groups , glycated hemoglobin ( HbA1 ) fell significantly before diet intervention began , remaining lower throughout the study and at follow-up 9 months later . Low-density lipoprotein ( LDL ) cholesterol showed a sustained fall in all groups after diet intervention . Apart from transient changes in high-density lipoprotein ( HDL ) cholesterol and triglyceride ( TG ) in the diet groups with the higher carbohydrate intake , no lasting differences were found between the three diet groups . CONCLUSIONS In the long term , there were few differences in the outcome of the three dietary prescriptions . Even with intensive instruction , participants found it difficult to meet recommended nutrient intakes ; however , specific dietary advice did result in an improvement in LDL cholesterol . Adverse changes in HDL cholesterol and TG because of diet intervention were transient . The significant improvement in glycemic control during the recruitment phase may have been the result of particpants ' previous dietary knowledge and the increased attention that they received during the intervention Background Low-carbohydrate diets have been shown to effectively improve the metabolic status of patients with type 2 diabetes mellitus . However , patients may find it challenging to maintain a strict low-carbohydrate diet . The objective of this study was to determine if a one-meal , low-carbohydrate diet is as effective in improving metabolic status as a conventional , energy-restricted diet among patients with type 2 diabetes mellitus . Methods In this 12-week r and omized controlled study , the primary endpoint was differences in the changes of plasma glycosylated hemoglobin ( HbA1c ) levels between the two experimental groups . Since the two groups had differences in body weight , body mass index , and waist circumference , propensity score matching was used to assess HbA1c outcomes via cohort pairs according to age , sex , body weight , HbA1c level , and waist circumference . Results There were no differences in the changes in HbA1c between the two groups ( P = 0.95 ) . In addition , there were no differences in the changes in glycated albumin , 1,5-anhydroglucitol , lipid profile , body weight , waist circumference , and fat mass between the two groups . The mini low-carbohydrate diet group had an increased protein intake ( P = 0.0085 ) , as compared with the control group . However , neither group showed changes in their Diabetes Treatment Satisfaction Question naire score . Conclusion Either diet would be effective for improving the metabolic status of this study population Elevated postpr and ial blood glucose levels constitute a global epidemic and a major risk factor for prediabetes and type II diabetes , but existing dietary methods for controlling them have limited efficacy . Here , we continuously monitored week-long glucose levels in an 800-person cohort , measured responses to 46,898 meals , and found high variability in the response to identical meals , suggesting that universal dietary recommendations may have limited utility . We devised a machine-learning algorithm that integrates blood parameters , dietary habits , anthropometrics , physical activity , and gut microbiota measured in this cohort and showed that it accurately predicts personalized postpr and ial glycemic response to real-life meals . We vali date d these predictions in an independent 100-person cohort . Finally , a blinded r and omized controlled dietary intervention based on this algorithm result ed in significantly lower postpr and ial responses and consistent alterations to gut microbiota configuration . Together , our results suggest that personalized diets may successfully modify elevated postpr and ial blood glucose and its metabolic consequences . VIDEO ABSTRACT Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies OBJECTIVE To evaluate the effects of qualitative dietary changes and the interaction with aerobic exercise training on liver fat content independent of weight loss in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS With use of a factorial 2 × 2 r and omized parallel-group design , 37 men and 8 women , aged 35–70 years , with type 2 diabetes in satisfactory blood glucose control on diet or diet plus metformin treatment  were assigned to one of the following groups for an 8-week period : 1 ) high-carbohydrate/high-fiber/low – glycemic index diet ( CHO/fiber group ) , 2 ) high-MUFA diet ( MUFA group ) , 3 ) high-carbohydrate/high-fiber/low – glycemic index diet plus physical activity program ( CHO/fiber+Ex group ) , and 4 ) high-MUFA diet plus physical activity program ( MUFA+Ex group ) . Before and after intervention , hepatic fat content was measured by 1H NMR . RESULTS Dietary compliance was optimal and body weight remained stable in all groups . Liver fat content decreased more in MUFA ( −29 % ) and MUFA+Ex ( −25 % ) groups than in CHO/fiber ( −4 % ) and CHO/fiber+Ex groups ( −6 % ) . Two-way repeated- measures ANOVA , including baseline values as covariate , showed a significant effect on liver fat content for diet ( P = 0.006 ) , with no effects for exercise training ( P = 0.789 ) or diet-exercise interaction ( P = 0.712 ) . CONCLUSIONS An isocaloric diet enriched in MUFA compared with a diet higher in carbohydrate and fiber was associated with a clinical ly relevant reduction of hepatic fat content in type 2 diabetic patients independent of an aerobic training program and should be considered for the nutritional management of hepatic steatosis in people with type 2 diabetes Objective Dietary carbohydrate is the major determinant of postpr and ial glucose levels , and several clinical studies have shown that low-carbohydrate diets improve glycemic control . In this study , we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus . Research design and methods Eighty-four community volunteers with obesity and type 2 diabetes were r and omized to either a low-carbohydrate , ketogenic diet ( < 20 g of carbohydrate daily ; LCKD ) or a low-glycemic , reduced-calorie diet ( 500 kcal/day deficit from weight maintenance diet ; LGID ) . Both groups received group meetings , nutritional supplementation , and an exercise recommendation . The main outcome was glycemic control , measured by hemoglobin A1c . Results Forty-nine ( 58.3 % ) participants completed the study . Both interventions led to improvements in hemoglobin A1c , fasting glucose , fasting insulin , and weight loss . The LCKD group had greater improvements in hemoglobin A1c ( -1.5 % vs. -0.5 % , p = 0.03 ) , body weight ( -11.1 kg vs. -6.9 kg , p = 0.008 ) , and high density lipoprotein cholesterol ( + 5.6 mg/dL vs. 0 mg/dL , p < 0.001 ) compared to the LGID group . Diabetes medications were reduced or eliminated in 95.2 % of LCKD vs. 62 % of LGID participants ( p < 0.01 ) . Conclusion Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes . The diet lower in carbohydrate led to greater improvements in glycemic control , and more frequent medication reduction/elimination than the low glycemic index diet . Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes OBJECTIVE To compare the effects of a 1-year intervention with a low-carbohydrate and a low-fat diet on weight loss and glycemic control in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS This study is a r and omized clinical trial of 105 overweight adults with type 2 diabetes . Primary outcomes were weight and A1C . Secondary outcomes included blood pressure and lipids . Outcome measures were obtained at 3 , 6 , and 12 months . RESULTS The greatest reduction in weight and A1C occurred within the first 3 months . Weight loss occurred faster in the low-carbohydrate group than in the low-fat group ( P = 0.005 ) , but at 1 year a similar 3.4 % weight reduction was seen in both dietary groups . There was no significant change in A1C in either group at 1 year . There was no change in blood pressure , but a greater increase in HDL was observed in the low-carbohydrate group ( P = 0.002 ) . CONCLUSIONS Among patients with type 2 diabetes , after 1 year a low-carbohydrate diet had effects on weight and A1C similar to those seen with a low-fat diet . There was no significant effect on blood pressure , but the low-carbohydrate diet produced a greater increase in HDL cholesterol Fifteen non-insulin-dependent diabetic patients with persistently elevated blood glucoses despite high doses of oral hypoglycaemic agents , were r and omly allocated to a high carbohydrate-high fibre diet ( HC ) or a reinforced low carbohydrate diet ( LC ) . After six weeks the diets were reversed for a similar period . Immediately preceding the study and at the end of each dietary period 24-h biochemical profiles were performed . In the 11 patients who completed the study , fasting and prepr and ial glucose , percentage glycosylated haemoglobin , VLDL cholesterol and mean 24-h triglycerides were significantly lower on HC than on LC or during the initial profile on their usual diet . There was no significant difference in any of the measurements on LC compared with the usual diet . Previous studies of high carbohydrate-high fibre diets in diabetes have been carried out in relatively well-controlled patients . These data show that poorly controlled non-insulin-dependent patients have an even more striking response Our aims were 1 ) to examine the effects of a high-carbohydrate low-fat diet on fasting and postpr and ial plasma lipids , apolipoproteins ( apo ) , and lipoprotein composition in noninsulin-dependent diabetes mellitus , and 2 ) to determine whether postpr and ial shift of apo between triglyceride-rich lipoproteins ( TRLP ) and high density lipoproteins ( HDL ) is affected by diet . A cross-over study , of 4 weeks duration , of a high-carbohydrate ( 60 % carbohydrate , 20 % fat ) and a high-fat ( 40 % carbohydrate , 40 % fat ) diet was performed in seven subjects with noninsulin-dependent diabetes mellitus .  TRLP , low density lipoproteins ( LDL ) , and HDL were separated by fast protein liquid chromatography . The high-carbohydrate diet result ed in a decrease of fasting total , HDL , and LDL cholesterol and a trend toward an increase in plasma triglycerides . The apo composition of fasting TRLP and HDL was similar on both diets . TRLP apo CII , CIII , and E increased whereas HDL apo CII , CIII , and E decreased postpr and ially on both diets . In contrast , TRLP apo CI increased , and HDL apo CI decreased only after the high-carbohydrate diet . We conclude that 1 ) a high carbohydrate diet results in a decrease in total , LDL , and HDL cholesterol and a trend toward an increase in plasma triglycerides ; 2 ) fasting TRLP and HDL apo composition was similar on a high-carbohydrate or a high-fat diet ; and 3 ) on both diets , apo CII , CIII , and E transfer from HDL to TRLP postpr and ially . However , only the high-carbohydrate diet induced postpr and ial transfer of apo CI from HDL to TRLP . This may explain in part the changes in lipoproteins observed with this diet OBJECTIVE To examine the effects of a high-carbohydrate low-fat ( HCLF ) and a modified-fat ( MF ) diet on body weight and metabolic control in subjects with non-insulin-dependent diabetes mellitus ( NIDDM ) living at home . RESEARCH DESIGN AND METHODS Twenty-four NIDDM patients followed HCLF and MF diets alternately and in r and om order for a 3-month period while at home , with a 1-month baseline and washout between diets . Before and after each diet , fasting glucose and lipids , HbAlc , blood pressure , and body weight were measured . Dietary preferences were assessed by question naire . RESULTS Subjects consumed 50 % of energy as carbohydrate and 23 % as fat on the HCLF diet and 40 % of energy as carbohydrate and 36 % as fat ( over half of which was monounsaturated fat ) on the MF diet . Subjects lost weight on both HCLF and MF diets ( mean loss 0.7 and 1.3 kg , respectively ) . Although the MF diet result ed in a small decrease in fasting glucose levels , there was no significant change in HbA1c . Similarly , there was no significant difference between the diets in changes in blood pressure or fasting blood lipids . Most subjects ( 65 % ) preferred the MF diet . CONCLUSIONS Although the MF diet is not a low-fat diet , it did not appear to facilitate weight gain in subjects with NIDDM living at home . The MF diet provides an alternative for individuals unable to comply with HCLF diets OBJECTIVE To underst and why low-fat high-carbohydrate ( CHO ) diets lead to higher fasting and postpr and ial concentrations of triglyceride (TG)-rich lipoproteins in patients with non-insulin-dependent diabetes mellitus ( NIDDM ) . RESEARCH DESIGN AND METHODS Patients with NIDDM were placed r and omly on diets containing either 55 % CHO , 30 % fat , and 15 % protein or 40 % CHO , 45 % fat , and 15 % protein for 6 weeks , followed by crossover to the other diet . Test meals at the end of each diet period were consumed at 8:00 A.M. and 12:00 P.M. ( noon ) and contained 20 and 40 % of daily calories , respectively . Vitamin A was also given at noon , and TG-rich lipoproteins of intestinal origin were identified by the presence of vitamin A esters . Frequent measurements were made throughout the 24-h study period of plasma glucose , insulin , and TG concentrations . Plasma sample s obtained from 12:00 P.M. ( noon ) until 12 A.M. ( midnight ) were subjected to ultracentrifugation , and measurements were made of TG and vitamin A ester concentrations in plasma and in both the Svedberg flotation constant ( Sf ) > 400 ( chylomicron ) and Sf 20 - 400 ( chylomicron remnant ) lipoprotein fractions . In addition , very-low-density lipoprotein (VLDL)-TG turnover rate was estimated by following the decay of [3H]VLDL-TG . Finally , postheparin lipoprotein lipase and hepatic lipase activities were measured at the end of each dietary period . RESULTS Mean ± SE hourly concentrations of glucose ( 8.0 ± 0.8 vs. 7.5 ± 0.7 mmol/1 ) , insulin ( 184 ± 26 vs. 158 ± 19 pmol/1 ) , and TG ( 2.8 ± 0.2 vs. 2.1 ± 0.2 mmol/1 ) were higher ( P < 0.05 - 0.001 ) after the 55 % CHO diet . The 55 % CHO diet also led to an increase ( P < 0.05 - 0.01 ) in the mean ± SE hourly concentrations of vitamin A esters in plasma ( 2.3 ± 0.3 vs. 1.6 ±0.1 μmol/l ) and in both the chylomicron ( 2.0 ± 0.3 vs. 1.4 ±0.1 μmol/l ) and chylomicron remnant fractions ( 0.36 ± 0.04 vs. 0.14 ± 0.03 μmol;/l ) . In addition , the VLDL-TG production rate was higher ( 17.2 ± 1.4 vs. 12.8 ± 1.0 mg · kg−1 · h−1 , P < 0.003 ) and the VLDL-TG fractional catabolic rate lower ( 0.22 ± 0.02 to 0.28 ± 0.02 l/h , P < 0.005 ) after the 55 % CHO diet . Finally , there was an increase in lipoprotein lipase activity ( 7.0 ± 0.8 to 8.1 ± 0.7 μmol free fatty acids released · ml−1 · h−1 , P < 0.02 ) in response to the CHO-enriched diet . CONCLUSIONS A low-fat high-CHO diet in patients with NIDDM led to 1 ) higher day-long plasma glucose , insulin , and TG concentrations ; 2 ) postpr and ial accumulation of TG-rich lipoproteins of intestinal origin ; 3 ) increased production of VLDL-TG ; and 4 ) increased postheparin lipoprotein lipase activity . These data provide a mechanism for the hypertriglycer-idemic effect of CHO-enriched diets in patients with NIDDM and demonstrate that multiple risk factors for coronary heart disease are accentuated when these individuals consume diets recommended to reduce this risk We compared a high-carbohydrate diet with a high-fat diet ( specifically , a diet high in monounsaturated fatty acids ) for effects on glycemic control and plasma lipoproteins in 10 patients with non-insulin-dependent diabetes mellitus ( NIDDM ) receiving insulin therapy . The patients were r and omly assigned to receive first one diet and then the other , each for 28 days , in a metabolic ward . In the high-carbohydrate diet , 25 percent of the energy was in the form of fat and 60 percent in the form of carbohydrates ( 47 percent of the total energy was in the form of complex carbohydrates ) ; the high-monounsaturated-fat diet was 50 percent fat ( 33 percent of the total energy in the form of monounsaturated fatty acids ) and 35 percent carbohydrates . The two diets had the same amounts of simple carbohydrates and fiber . As compared with the high-carbohydrate diet , the high-monounsaturated-fat diet result ed in lower mean plasma glucose levels and reduced insulin requirements , lower levels of plasma triglycerides and very-low-density lipoprotein cholesterol ( lower by 25 and 35 percent , respectively ; P less than 0.01 ) , and higher levels of high-density lipoprotein ( HDL ) cholesterol ( higher by 13 percent ; P less than 0.005 ) . Levels of total cholesterol and low-density lipoprotein ( LDL ) cholesterol did not differ significantly in patients on the two diets . These preliminary results suggest that partial replacement of complex carbohydrates with monounsaturated fatty acids in the diets of patients with NIDDM does not increase the level of LDL cholesterol and may improve glycemic control and the levels of plasma triglycerides and HDL cholesterol BACKGROUND For many people , maintenance of weight loss is elusive . Whereas high-protein ( HP ) diets have been found to be superior to high-carbohydrate ( HC ) diets for weight loss in the short term , their benefits long term are unclear , particularly for weight maintenance . Furthermore , the literature lacks consensus on the long-term effects of an HP diet on cardiovascular disease risk factors . OBJECTIVE The objective was to investigate whether macronutrient dietary composition plays a role in weight maintenance and in improvement of cardiovascular disease risk factors . DESIGN The study comprised 2 phases . Phase 1 featured a very-low-energy diet for 3 mo . In phase 2 , the subjects were r and omly assigned to an HP or an HC diet for 12 mo . The diets were isocaloric , tightly controlled , and individually prescribed for weight maintenance . The subjects were overweight or obese but otherwise healthy men and women . RESULTS The subjects lost an average of 16.5 kg during phase 1 and maintained a mean ( + /-SEM ) weight loss of 14.5 + /- 1.2 kg ( P < 0.001 ) during phase 2 ; no significant differences between groups were observed . By the end of the study , reductions in systolic blood pressure were 14.3 + /- 2.4 mm Hg for the HP group and 7.7 + /- 2.2 mm Hg for the HC group ( P < 0.045 ) . Forty-seven percent of the 180 subjects who began the study completed both phases . CONCLUSIONS The results indicate that the protein or carbohydrate content of the diet has no effect on successful weight-loss maintenance . A general linear model analysis indicated that dietary treatment ( HP or HC ) was a significant factor in systolic blood pressure change and in favor of the HP diet . This trial was registered at www . clinical trials.gov as NCT 00625236 OBJECTIVE To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non-insulin-dependent diabetes mellitus ( NIDDM ) . DESIGN A four-center r and omized crossover trial . SETTING Outpatient and inpatient evaluation in metabolic units . PATIENTS Forty-two NIDDM patients receiving glipizide therapy .  INTERVENTIONS A high-carbohydrate diet containing 55 % of the total energy as carbohydrates and 30 % as fats was compared with a high-monounsaturated-fat diet containing 40 % carbohydrates and 45 % fats . The amounts of saturated fats , polyunsaturated fats , cholesterol , sucrose , and protein were similar . The study diets , prepared in metabolic kitchens , were provided as the sole nutrients to subjects for 6 weeks each . To assess longer-term effects , a subgroup of 21 patients continued the diet they received second for an additional 8 weeks . MAIN OUTCOME MEASURES Fasting plasma glucose , insulin , lipoproteins , and glycosylated hemoglobin concentrations . Twenty-four-hour profiles of glucose , insulin , and triglyceride levels . RESULTS The site of study as well as the diet order did not affect the results . Compared with the high-monounsaturated-fat diet , the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24 % ( P < .0001 ) and 23 % ( P = .0001 ) , respectively , and increased daylong plasma triglyceride , glucose , and insulin values by 10 % ( P = .03 ) , 12 % ( P < .0001 ) , and 9 % ( P = .02 ) , respectively . Plasma total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol levels remained unchanged . The effects of both diets on plasma glucose , insulin , and triglyceride levels persisted for 14 weeks . CONCLUSIONS In NIDDM patients , high-carbohydrate diets compared with high-monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia , as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels , which may not be desirable OBJECTIVE We compared the effects of a low glycemic index ( GI ) diet with the American Diabetes Association ( ADA ) diet on glycosylated hemoglobin ( HbA1c ) among individuals with type 2 diabetes . METHODS Forty individuals with poorly controlled type 2 diabetes were r and omized to a low-GI or an ADA diet . The intervention , consisting of eight educational sessions ( monthly for the first 6 mo and then at months 8 and 10 ) , focused on a low-GI or an ADA diet .  Data on demographics , diet , physical activity , psychosocial factors , and diabetes medication use were assessed at baseline and 6 and 12 mo . Generalized linear mixed models were used to compare the two groups on HbA1c , diabetic medication use , blood lipids , weight , diet , and physical activity .  RESULTS Participants ( 53 % female , mean age 53.5 y ) were predominantly white with a mean body mass index of 35.8 kg/m(2 ) . Although both interventions achieved similar reductions in mean HbA1c at 6 mo and 12 mo , the low-GI diet group was less likely to add or increase dosage of diabetic medications ( odds ratio 0.26 , P = 0.01 ) . Improvements in high-density lipoprotein cholesterol , triacylglycerols , and weight loss were similar between groups . CONCLUSION Compared with the ADA diet , the low-GI diet achieved equivalent control of HbA1c using less diabetic medication . Despite its limited size , this trial suggests that a low-GI diet is a viable alternative to the ADA diet . Findings should be evaluated in a larger r and omized controlled trial Summary Type 2 ( insulin independent ) diabetic women were r and omly allocated to receive advice for low fat diets or low carbohydrate diets . By 24 h weighed dietary intakes before and after a mean interval of six months , patients in the low fat group had reduced their fat intake from 41 % to 31 % of total energy , while carbohydrate percentage of total energy intake increased from 38 % to 46 % . Percentage energy intake from fat and carbohydrate in the control group remained unchanged . Body weight fell in both groups , especially for patients in the low fat group who were obese ( weight/height2 ⩾ 28 kg/m2 ) . Mean plasma glucose , HbA1 , and triglycerides were unchanged . Mean plasma total cholesterol fell significantly in the low fat group compared with the controls ( p < 0.001 ) , but there was no significant difference in the small reduction of high density lipoprotein cholesterol observed in both groups . Thus , adherence to low fat diets occurred without deterioration of diabetes and with benefit for weight and total cholesterol OBJECTIVE To investigate whether blood pressure is different in type 2 diabetic patients on a diet rich in carbohydrates versus a diet rich in cis-monounsaturated fatty acids . Data on the dietary effects on these diets ' glucose and lipid metabolism have been previously published . RESEARCH DESIGN AND METHODS The study compared the effect of feeding 42 type 2 diabetic patients a carefully controlled isoenergic high-carbohydrate ( high-carb ; 55 % energy as carbohydrate , 30 % as fat , and 10 % as monounsaturated fat ) and high-monounsaturated fat ( high-mono ; 45 % energy as fat , 25 % as monounsaturated fat , and 40 % as carbohydrate ) diet for 6 weeks each in a four-center , r and omized , cross-over study on blood pressure . Twenty-one patients continued the diet they received during the second phase for an additional 8 weeks . RESULTS According to repeated- measures ANOVA , blood pressure during the last 3 days of each phase was similar after 6 weeks of the high-carb and high-mono diets ( systolic blood pressure : 128 + /- 16 vs. 127 + /- 15 mmHg , P = 0.9 ; diastolic blood pressure : 75 + /- 7 vs. 75 + /- 8 mmHg , P = 0.7 ) . However , after 14 weeks of the high-carb diet ( n = 13 ) , there was a significant increase in blood pressure compared with 6 weeks of the high-mono diet ( systolic blood pressure : 132 + /- 13 vs. 126 + /- 11 mmHg , P = 0.04 ; diastolic blood pressure : 83 + /- 6 vs. 76 + /- 7 mmHg , P = 0.002 ) . After 14 weeks of the high-mono diet ( n = 8) , the reduction in blood pressure was not significant compared with 6 weeks of the high-carb diet ( systolic blood pressure : 118 + /- 14 vs. 121 + /- 16 mmHg , P = 0.4 ; diastolic blood pressure : 71 + /- 8 vs. 75 + /- 10 mmHg , P = 0.3 ) . CONCLUSION Although the exchange of carbohydrates with monounsaturated fats may not affect blood pressure in the short term , long-term consumption of a high-carbohydrate diet may modestly raise blood pressure in type 2 diabetic patients 1 . A prospect i ve r and omized study of two dietary regimens has been started in newly-diagnosed diabetics to determine their effect on circulating metabolites and on diabetic complications . 2 . During the first year of treatment the fasting plasma glucose concentrations on both the low-carbohydrate diet and the high-carbohydrate , modified-fat ( MF ) diet showed a similar decrease . 3 . Plasma cholesterol showed a sustained decrease only in patients recommended a MF diet . Transient changes in plasma triglyceride concentrations occurred in patients on both dietary regimens . 4 . Increased plasma cholesterol levels are associated with atheromatous disease which is common in diabetics in Europe and North America . A MF diet may therefore have an advantage in that it lowers the plasma cholesterol as well as being effective in lowering the plasma glucose A group of non-insulin dependent diabetics taking oral hypoglycaemic therapy  were studied to determine the effect of improved diabetic control on the platelet levels of the prostagl and in precursor fatty acids . The patients were r and omised to receive either a low carbohydrate diet ( 35 % of total energy ) for six weeks or a high carbohydrate diet ( 55 % of total energy ) , high fibre diet for six weeks and the diets were then reversed . At the end of the high carbohydrate , high fibre diet the mean fasting blood glucose ( 6.6 mmol section 1 ) and mean percentage glycosylated haemoglobin ( 8.2 % ) were significantly lower than after the low carbohydrate diet ( 7.8 . mmol/l , p less than 0.05 : 9.9 % , p less than 0.01 ) . Mean platelet phospholipid arachidonic acid percentage was significantly higher after the high carbohydrate , high fibre diet ( 24.2 % ) than after the low carbohydrate diet ( 19.9 % , p less than 0.01 ) . There were no significant changes in the other platelet fatty acids Although low-fat high-carbohydrate diets are recommended for patients with non-insulin-dependent diabetes mellitus ( NIDDM ) in an effort to reduce the risk of coronary artery disease ( CAD ) , the results of short-term studies have shown that these diets can lead to changes in carbohydrate and lipid metabolism associated with an increased risk of CAD . This study has extended these earlier observations by determining the metabolic effects of such diets over a longer period in these patients . The comparison diets contained either 40 or 60 % of the total calories as carbohydrates , with reciprocal changes in fat content from 40 to 20 % consumed in r and om order for 6 wk in a crossover experimental design . The ratio of polyunsaturated to saturated fat and the total cholesterol intake were held constant in the two diets . Plasma glucose and insulin concentrations were significantly ( P < .001 ) elevated throughout the day when patients consumed the 60 % carbohydrate diet , and 24-h urinary glucose excretion more than doubled ( 0.8 vs. 1.8 mol/24 h ) . Fasting plasma total and very-low-density lipoprotein ( VLDL ) triglyceride ( TG ) concentrations increased by 30 % ( P < .001 ) after 1 wk on the 60 % carbohydrate diet , and the magnitude of carbohydrate-induced hypertriglyceridemia persisted unchanged throughout the 6-wk study period . Total plasma cholesterol concentrations were similar after both diets . However , VLDL cholesterol ( VLDL-chol ) was significantly increased , whereas both low-density lipoprotein ( LDL- ) and high-density lipoprotein ( HDL- ) chol concentrations were significantly decreasedafter consumption of the 60 % carbohydrate diet . Consequently , neither total-chol-to-HDL-chol nor LDL-chol-to-HDL-chol ratios changed . The results of this study indicate that high-carbohydrate diets lead to several changes in carbohydrate and lipid metabolism in patients with NIDDM that could lead to an increased risk of CAD , and these effects persist for > 6 wk . Given these results , it seems reasonable to suggest that the routine recommendation of low-fat high-carbohydrate diets for patients with NIDDM be reconsidered OBJECTIVE To determine the optimal diet for improving glucose and lipid profiles in obese patients with type 2 diabetes during moderate energy restriction . RESEARCH DESIGN AND METHODS A total of 35 free-living obese patients with type 2 diabetes were assigned to one of three 1,600 kcal/day diets for 12 weeks . The diets were high carbohydrate ( 10 % fat , 4 % saturated ) , high monounsaturated fat ( MUFA ) ( 32 % fat , 7 % saturated ) , or high saturated fat ( SFA ) ( 32 % fat , 17 % saturated ) . RESULTS Diet composition did not affect the magnitude of weight loss , with subjects losing an average of 6.6 + /- 0.9 kg . Energy restriction and weight loss result ed in reductions in fasting plasma glucose ( -14 % ) , insulin ( -27 % ) , GHb ( -14 % ) , and systolic ( -7 % ) and diastolic blood pressure ( -10 % ) levels and the glucose response area ( -17 % ) independent of diet composition . Diet composition did affect the lipoprotein profile . LDL was 10 % and 17 % lower with the high-carbohydrate and high-MUFA diets , respectively , whereas no change was observed with the high-SFA diet ( P < 0.001 for effect of diet ) . HDL was transiently reduced on the high-carbohydrate diet at weeks 1 , 4 , and 8 , whereas higher fat consumption maintained these levels . The total cholesterol : HDL ratio , although significantly reduced on the high-MUFA diet ( P < 0.01 ) , was not different from the other two diets after adjustment for baseline differences . CONCLUSIONS Energy restriction , independent of diet composition , improves glycemic control ; however , reducing SFA intake by replacing SFA with carbohydrate or MUFA reduces LDL maximally during weight loss and to a greater degree than has been shown in weight-stable studies In comparison to a traditional low carbohydrate diet ( LC ) , the effect of an isocaloric high carbohydrate , high fibre diet ( HC ) upon the insulin binding to mononuclear blood cells of seven non-insulin-dependent diabetics was examined . Each subject , in r and om order , took both diets for 6 weeks each . There was no significant difference in weight during either dietary period , but a significant ( P less than 0.05 ) increase in the monocyte insulin binding activity on the HD diet ( tracer specific binding : 4.2 % HC ; 3.5 % LC ) . This was accompanied by a significantly ( P less than 0.02 ) lower fasting plasma glucose concentration ( LC = 7.1 mmol/l ; HC = 6.1 ) without a significant change in the fasting plasma insulin level . In contrast to the usual low carbohydrate diet , a high carbohydrate diet tends to correct the lowered insulin receptor status observed in maturity-onset diabetics In a r and omised cross-over study 18 nondependent ( NIDDM ) and 9 insulin-dependent ( IDDM ) diabetics were put on to a high carbohydrate diet containing leguminous fibre ( HL ) for 6 weeks , and also a st and ard low carbohydrate diet ( LC ) for 6 weeks . During two identical 24 h metabolic profiles mean prepr and ial and mean 2 hour postpr and ial blood glucoses were significantly lower on HL in both groups , as were also several overall measures of diabetic control , including the degree of glycosuria . Total cholesterol was reduced significantly on HL in both groups , and the HDL/LDL cholesterol ratio increased significantly on HL in the NIDDM group . A diet high in complex carbohydrate and leguminous fibre improves all aspects of diabetic control , and continued use of a low carbohydrate diet no longer appears justified OBJECTIVE This study sought to examine the effects of a 3-month programme of dietary advice to restrict carbohydrate intake compared with reduced-portion , low-fat advice in obese subjects with poorly controlled Type 2 diabetes . RESEARCH DESIGN AND METHODS One hundred and two patients with Type 2 diabetes were recruited across three centres and r and omly allocated to receive group education and individual dietary advice .  Weight , glycaemic control , lipids and blood pressure were assessed at baseline and 3 months . Dietary quality was assessed at the end of study . RESULTS Weight loss was greater in the low-carbohydrate ( LC ) group ( -3.55 + /- 0.63 , mean + /- sem ) vs. -0.92 + /- 0.40 kg , P = 0.001 ) and cholesterol : high-density lipoprotein ( HDL ) ratio improved ( -0.48 + /- 0.11 vs. -0.10 + /- 0.10 , P = 0.01 ) . However , relative saturated fat intake was greater ( 13.9 + /- 0.71 vs. 11.0 + /- 0.47 % of dietary intake , P < 0.001 ) , although absolute intakes were moderate . CONCLUSIONS Carbohydrate restriction was an effective method of achieving short-term weight loss compared with st and ard advice , but this was at the expense of an increase in relative saturated fat intake Approximately 80 % of patients with type 2 diabetes are overweight/obese ( 1 ) , and weight loss is the mainstay of treatment for these individuals . However , there is growing controversy as to whether reduced-fat or reduced-carbohydrate diets are best suited for this purpose , and results ( 2–8 ) in nondiabetic subjects suggest that lower carbohydrate diets are similarly or more efficacious in improving weight , triglycerides , and HDL cholesterol . There are no published r and omized studies evaluating the role of dietary macronutrients with respect to weight loss and cardiovascular risk improvement in patients with type 2 diabetes . Thus , we r and omized diet-treated patients with type 2 diabetes to hypocaloric diets , moderately restricted in either carbohydrate or fat , to determine whether weight loss or metabolic improvement differed as a function of macronutrient composition . A total of 29 patients with diet-treated type 2 diabetes were recruited from the San Francisco Bay area . All subjects gave written informed consent . Inclusion criteria included BMI 27–36 kg/m2 , fasting plasma glucose concentration 7.2–8.3 mmol/l , no use of antihyperglycemic medications , and stable weight for 3 months . Subjects on anti-hypertensive or cholesterol-lowering drugs or aspirin were allowed to continue their medications . Insulin-mediated glucose uptake was quantified by a modification ( 9 ) of the insulin suppression test as originally described ( 10 ) and vali date d ( 11 ) . In this test , a 180-min infusion of somatostatin ( 0.27 μg/m2 per min ) , insulin ( 25 mU/m2 per min ) , High-density lipoprotein ( HDL ) plays an important role in the process of reverse cholesterol transport , which may become suboptimal with increasing body fatness . HDL cholesterol that is reduced in obese subjects paradoxically decreases during weight reduction . To determine how weight reduction affects HDL subclasses that are involved in reverse cholesterol transport , we studied HDL from obese diabetic subjects before and after energy restriction within background diets high in either carbohydrate or monounsaturated fatty acids ( MUFAs ) .  Body weight , blood glucose , total cholesterol , and LDL cholesterol decreased after 8 and 12 weeks of weight reduction . With the very-low-fat diet , HDL cholesterol decreased significantly at 8 weeks , but recovered to initial levels after 12 weeks as body weight began to stabilize . Plasma apolipoprotein A-I ( apo A-I ) decreased substantially and significantly at 8 and 12 weeks with both diets , and was reflected in the reduction of apo A-I in HDL subclasses alpha1 , alpha2 , pre-beta1 , and pre-beta2 + pre-beta3 . The calculation of the percentage distribution of apo A-I among HDL species showed that only the proportion of pre-beta1-HDL decreased , whereas alpha2-HDL increased . This led to a significant increase in the alpha1 + alpha2/pre-beta ratio , ie , the ratio of the large cholesterol " storage " or " sink " HDL to the HDL " shuttle " fraction considered to be the initial acceptor of cell cholesterol . These data suggest that despite the reduction in HDL cholesterol and apo A-I , the redistribution of apo A-I in pre-beta1-HDL and alpha-HDL observed with weight reduction appears to revert to the pattern that we have previously reported in lean as opposed to overweight subjects OBJECTIVE To evaluate whether plasma fibrinogen concentration is correlated with the level of physical activity and aerobic power in patients with newly diagnosed non-insulin-dependent diabetes mellitus ( NIDDM ) . RESEARCH DESIGN AND METHODS We studied 78 middle-aged ( 54 ± 6 years , mean ± SD ) , obese ( body mass index [ BMI ] 32 ± 5 kg/m2 ) patients ( 45 men and 33 women ) before and after a 12-month treatment period consisting of either conventional treatment given by community health centers or intensified dietary and exercise education given by a university outpatient clinic . Plasma fibrinogen concentration was measured by using a coagulometer . Physical activity  was assessed by a question naire , and the patients were classified into a sedentary group or moderately or intensively exercising groups . Aerobic power ( maximum oxygen uptake [ ] , anaerobic threshold [ ] ) was measured by direct breath-by-breath technique . RESULTS At baseline , the sedentary patients had higher fibrinogen concentration than those with moderate or high physical activities ( 3.8 ± 0.8 vs. 3.3 ± 0.7 g/I , P < 0.01 ) . Both and ( ml · min−1 · kg−1 ) showed an inverse linear correlation with fibrinogen ( r = -0.38 , P < 0.001 , and r = -0.29 , P < 0.01 , respectively ) . In the step wise multiple regression analysis , BMI , Vo2 max ( ml/min ) , and smoking were the only significant independent factors explaining 23 % of the variance in fibrinogen concentration . In sedentary patients , poor glycemie control was related with high fibrinogen concentration . During the follow-up period , patients maintained , on the average , good to moderate glycemie control . The originally sedentary group showed a decrease in fibrinogen concentration ( to 3.3 ± 0.7 g/I , P < 0.001 ) that reached the same level that the physically more active groups had at baseline . This change was associated with improved glycemie control , but not with any of the other assessed factors , including fatty acid composition of serum lipids reflecting dietary intake of fats . CONCLUSIONS In addition to BMI and smoking , low reported physical activity and low aerobic power are independently associated with high plasma fibrinogen concentration in newly diagnosed NIDDM AIMS To compare the effects of a high-carbohydrate ( CHO ) diet and a high-monounsaturated fatty acid ( MUFA ) diet on LDL oxidative resistance in free-living individuals with Type 2 diabetes mellitus . METHODS Twenty-two men and women out- patients with Type 2 diabetes , with mean age 61 years and in fair metabolic control ( HbA1c<8.0 % ) , were enrolled at a university hospital lipid clinic in a r and omized , crossover feeding trial comparing two isocaloric diets for 6 weeks each : CHO ( fat , 28 % energy ) and MUFA ( fat , 40 % energy ) based on virgin olive oil . Outcome measurements were changes in LDL susceptibility to oxidation , body weight , glycaemic control , and lipoprotein profiles . RESULTS Planned and observed diets were well matched . Participants preferred the MUFA diet over the CHO diet . The lag time of conjugated diene formation during Cu2 + -induced LDL oxidation was similar after the CHO and MUFA diets ( 36.4 + /- 12.2 min and 36.0 + /- 13.7 min , respectively ) . Body weight , glycaemic control , total triglycerides , and total , LDL- and HDL-cholesterol levels also were similar after the two diets . Compared with the CHO diet , the MUFA diet lowered VLDL-cholesterol by 35 % ( P=0.023 ) and VLDL triglyceride by 16 % ( P=0.016 ) . CONCLUSIONS Natural food-based high-CHO and high-MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes . A MUFA diet is a good alternative to high-CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance In two groups of obese patients with type 2 diabetes the effects of 2 different diet compositions were tested with regard to glycaemic control and bodyweight . A group of 16 obese patients with type 2 diabetes was advised on a low-carbohydrate diet , 1800 kcal for men and 1600 kcal for women , distributed as 20 % carbohydrates , 30 % protein and 50 % fat .  Fifteen obese diabetes patients on a high-carbohydrate diet were control group .  Their diet , 1600 - 1800 kcal for men and 1400 - 1600 kcal for women , consisted of approximately 60 % carbohydrates , 15 % protein and 25 % fat . Positive effects on the glucose levels were seen very soon . After 6 months a marked reduction in bodyweight of patients in the low-carbohydrate diet group was observed , and this remained one year later . After 6 months the mean changes in the low-carbohydrate group and the control group respectively were ( + /-SD ) : fasting blood glucose ( f-BG ) : -3.4 + /- 2.9 and -0.6 + /- 2.9 mmol/l ; HBA1c : -1.4 + /- 1.1 % and -0.6 + /- 1.4 % ; Body Weight : -11.4 + /- 4 kg and -1.8 + /- 3.8 kg ; BMI : -4.1 + /- 1.3 kg/m _ and -0.7 + /- 1.3 kg/m_. Large changes in blood glucose levels were seen immediately . A low-carbohydrate diet is an effective tool in the treatment of obese patients with type 2 diabetes Low-carbohydrate diets have been associated with significant reductions in weight and HbA(1c ) in obese , diabetic participants who received high-intensity lifestyle modification for 6 or 12 months . This investigation sought to determine whether comparable results to those of short-term , intensive interventions could be achieved over a 24-month study period using a low-intensity intervention that approximates what is feasible in outpatient practice . A total of 144 obese , diabetic participants were r and omly assigned to a low-carbohydrate diet ( < 30 g/day ) or to a low fat diet ( < or=30 % of calories from fat with a deficit of 500 kcal/day ) . Participants were provided weekly group nutrition education sessions for the first month , and monthly sessions thereafter through the end of 24 months . Weight , HbA(1c ) , glucose , and lipids were measured at baseline and 6 , 12 , and 24 months . Of the 144 enrolled participants , 68 returned for the month 24 assessment visit .  Weights were retrieved from electronic medical records for an additional 57 participants ( total , 125 participants ) at month 24 . All participants with a baseline measurement and at least one of the three other measurements were included in the mixed-model analyses ( n = 138 ) . The low-intensity intervention result ed in modest weight loss in both groups at month 24 . At this time , participants in the low-carbohydrate group lost 1.5 kg , compared to 0.2 kg in the low-fat group ( P = 0.147 ) . Lipids , glycemic indexes , and dietary intake did not differ between groups at month 24 ( or at months 6 or 12 ) ( Clinical Trials.gov number , NCT00108459 ) BACKGROUND Low-carbohydrate diets are effective for weight reduction in people without diabetes , but there is limited evidence for people with Type 2 diabetes . Aims To assess the impact of a low-carbohydrate diet on body weight , glycated haemoglobin ( HbA(1c ) ) , ketone and lipid levels in diabetic and non-diabetic subjects . METHODS Thirteen Type 2 diabetic subjects ( on diet or metformin ) and 13 non-diabetic subjects were r and omly allocated to either a low-carbohydrate diet ( < or = 40 g carbohydrate/day ) or a healthy-eating diet following Diabetes UK nutritional recommendations and were seen monthly for 3 months . Subjects ( 25 % male ) were ( mean + /- sd ) age 52 + /- 9 years , weight 96.3 + /- 16.6 kg , body mass index 35.1 kg/m(2 ) , HbA(1c ) 6.6 + /- 1.1 % , total cholesterol 5.1 + /- 1.1 mmol/l , high-density lipoprotein cholesterol 1.3 + /- 0.4 mmol/l , low-density lipoprotein cholesterol 3.1 + /- 0.9 mmol/l , triglycerides ( geometric mean ) 1.55 ( 1.10 , 2.35 ) mmol/l and ketones range 0.0 - 0.2 mmol/l . RESULTS Analysis was by intention to treat with last observation carried forward . Twenty-two of the participants ( 85 % ) completed the study .  Weight loss was greater ( 6.9 vs. 2.1 kg , P = 0.003 ) in the low-carbohydrate group , with no difference in changes in HbA(1c ) , ketone or lipid levels . CONCLUSIONS The diet was equally effective in those with and without diabetes OBJECTIVE To comprehensively compare the effects of a very low-carbohydrate , high – unsaturated/low – saturated fat diet ( LC ) with those of a high – unrefined carbohydrate , low-fat diet ( HC ) on glycemic control and cardiovascular disease ( CVD ) risk factors in type 2 diabetes ( T2DM ) . RESEARCH DESIGN AND METHODS Obese adults ( n = 115 , BMI 34.4 ± 4.2 kg/m2 , age 58 ± 7 years ) with T2DM were r and omized to a hypocaloric LC diet ( 14 % carbohydrate [ < 50 g/day ] , 28 % protein , and 58 % fat [ < 10 % saturated fat ] ) or an energy-matched HC diet ( 53 % carbohydrate , 17 % protein , and 30 % fat [ < 10 % saturated fat ] ) combined with structured exercise for 24 weeks . The outcomes measured were as follows : glycosylated hemoglobin ( HbA1c ) , glycemic variability ( GV ; assessed by 48-h continuous glucose monitoring ) , antiglycemic medication changes ( antiglycemic medication effects score [ MES ] ) , and blood lipids and pressure . RESULTS A total of 93 participants completed 24 weeks . Both groups achieved similar completion rates ( LC 79 % , HC 82 % ) and weight loss ( LC −12.0 ± 6.3 kg , HC −11.5 ± 5.5 kg ) ; P ≥ 0.50 . Blood pressure ( −9.8/−7.3 ± 11.6/6.8 mmHg ) , fasting blood glucose ( −1.4 ± 2.3 mmol/L ) , and LDL cholesterol ( −0.3 ± 0.6 mmol/L ) decreased , with no diet effect ( P ≥ 0.10 ) . LC achieved greater reductions in triglycerides ( −0.5 ± 0.5 vs. −0.1 ± 0.5 mmol/L ) , MES ( −0.5 ± 0.5 vs. −0.2 ± 0.5 ) , and GV indices ; P  ≤ 0.03 . LC induced greater HbA1c reductions ( −2.6 ± 1.0 % [ −28.4 ± 10.9 mmol/mol ] vs. −1.9 ± 1.2 % [ −20.8 ± 13.1 mmol/mol ] ; P = 0.002 ) and HDL cholesterol ( HDL-C ) increases ( 0.2 ± 0.3 vs. 0.05 ± 0.2 mmol/L ; P = 0.007 ) in participants with the respective baseline values HbA1c > 7.8 % ( 62 mmol/mol ) and HDL-C < 1.29 mmol/L. CONCLUSIONS Both diets achieved substantial improvements for several clinical glycemic control and CVD risk markers . These improvements and reductions in GV and antiglycemic medication requirements were greatest with the LC compared with HC . This suggests an LC diet with low saturated fat may be an effective dietary approach for T2DM management if effects are sustained beyond 24 weeks Over the past decades , we have observed an increase of prevalence of diabetes  in many countries along with significant differences in prevalence trends between countries worldwide ( 1 ) . In Europe and other Western countries , the prevalence rate reaches a plateau or has slowed down on the level of ∼8–10 % . In Asia , a continuous rise in prevalence has been monitored , similar to that in Africa , and an explosion of diabetes prevalence can be observed in the Arabic region . Surprisingly , in each of the countries , there is a significant number of people who do not develop  diabetes  during their lives despite living unhealthy lifestyles in similar environments — in Europe , an estimated 10 % of the population ( 2 ) . These people might be the secret answer to successful individual diabetes prevention , but we still do not underst and the detailed mechanisms of why some people develop diabetes— and why others do not . What we can do is observe individual lifestyle and environment as determinants for the development or prevention of diabetes and the respective risk factors including genetic susceptibility . The interplay between these determinants , influencing the probability of the individual staying healthy or how a person learns or chooses a healthy lifestyle , will define success in diabetes prevention ( 3 ) . Innovative actions are needed to slow down the progression of type 2 diabetes . The purpose of this article is to offer innovative policy and environmental strategic activities design ed to enable sustainable diabetes prevention with scalability on national level . # # # Why Do We Need Environmental and Policy Changes in Diabetes Prevention ? Diabetes prevention is a success story , but it generates new challenges . Throughout the past 15 years , a number of r and omized controlled trials have sought to test various interventions to prevent diabetes ( 4 ) . The results are overwhelmingly positive on an individual level , with a significant relative diabetes risk reduction attributed to lifestyle and pharmacological intervention ( 5 Five quantitative measures of diabetic control [ HbA1c determinations , mean 24-h plasma glucose values , mean amplitude of glycemic excursions ( MAGE ) , mean 24-h urinary loss of glucose , and daily exogenous insulin requirement ] were compared in 20 pregnant women who were r and omly assigned to either a high-carbohydrate , high-fiber diet ( HCF ) that was low in fat or to a control diet commonly prescribed for pregnancy . Eleven women followed the HCF diet and nine subjects , the control diet , from baseline entry into the study until delivery . Dietary compliance was excellent , with 78 % of the women in each group rated good or acceptable . HbA1c values were similar in both groups at baseline ( HCF : 11.0 ± 0.5 % versus control : 10.2 ± 0.6 % ) , with no different predelivery values ( 8.6 ± 0.4 % ) . Mean 24-h plasma glucose levels improved in patients on both diets , with lower values noted in the HCF group at predelivery . MAGE values and st and ard deviations did not differ significantly in the two groups . Glycosuria decreased markedly in both dietary groups , but differences between groups were not significant . Improved control of diabetes on the HCF diet was achieved with significantly lower increments in insulin dose during gestation ( HCF baseline : 32 ± 8 U/24 h to 66 ± 10 U/24 h versus control baseline : 27 ± 9 U/24 h to 108 ± 12 U/24 h , P < 0.03 ) . Outcome of pregnancy did not differ in the two groups of patients , but women on the HCF diet gained less weight than those on the control diet ( 26 ± 3 lb versus 35 ± 5 lb , P < 0.05 ) . Mean newborn gestational age was similar in the two groups ( HCF : 37.2 ± 0.7 wk versus control : 36.5 ± 0.7 wk ) . Mean birth weight in infants of HCF mothers ± was 3809 ± 248 g versus 3313 ± 278 g in infants of control mothers ( P < 0.05 ) . We conclude that although marked improvement of diabetic control occurred on both regimens , patients on the HCF diet achieved better control of diabetes with significantly lower increments in exogenous insulin
target: There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
  There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
  Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
background: Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
  Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .