(26-08-14) Three-graded stratification of carbohydrate restriction by level of baseline hemoglobin A1c for type 2 diabetes patients

Three-graded stratification of carbohydrate restriction by level of baseline hemoglobin A1c for type 2 diabetes patients with a moderate low-carbohydrate diet

Hajime Haimoto, Tae Sasakabe, Takahiko Kawamura, Hiroyuki Umegaki, Masashi Komeda and Kenji Wakai

Abstract

Background:
A moderate low-carbohydrate diet has been receiving attention in the dietary management of
type 2 diabetes (T2DM). A fundamental issue has still to be addressed; how much carbohydrate delta-reduction
(¦¤carbohydrate) from baseline would be necessary to achieve a certain decrease in hemoglobin A1c (HbA1c) levels.
Objective:
We investigated the effects of three-graded stratification of carbohydrate restriction by patient baselineHbA1c levels on glycemic control and effects of ¦¤carbohydrate on decreases in HbA1c levels (¦¤ HbA1c) in each group.Research design and methods:We treated 122 outpatients with T2DM by three-graded carbohydrate restriction according to baseline HbA1c levels
(¡Ü7.4% for Group 1, 7.5%-8.9% for Group 2 and ¡Ý9.0% for Group 3) and assessed their HbA1c levels, doses of anti-diabetic drugs and macronutrient intakes over 6 months.

Results:

At baseline, the mean HbA1c level and carbohydrate intake were 6.9 ¡À 0.4% and 252 ¡À 59 g/day for Group 1(n = 55), 8.1 ¡À 0.4% and 282 ¡À 85 g/day for Group 2 (n = 41) and 10.6 ¡À 1.4% and 309 ¡À 88 g/day for Group 3 (n = 26).
Following three-graded carbohydrate restriction for 6 months significantly decreased mean carbohydrate intake (g/day) and HbA1c levels for all patients, from 274 ¡À 78 to 168 ¡À 52 g and from 8.1 ¡À 1.6 to 7.1 ¡À 0.9% (n = 122,P< 0.001 forboth) and anti-diabetic drugs could be tapered.
¦¤HbA1c and ¦¤carbohydrate were −0.4 ¡À 0.4% and −74 ¡À 69 g/day for Group 1,− 0.6 ¡À 0.9% and−117 ¡À 78 g/day for Group 2 and−3.1 ¡À 1.4% and −156 ¡À 74 g/day for Group 3. Linear regression analysis showed that the greater the carbohydrate intake, the greater the HbA1c levels at baseline(P= 0.001). Also, the greater the reduction in carbohydrate intake (g/day), the greater the decrease in HbA1c levels(P< 0.001), but ¦¤HbA1c was not significantly influenced by changes in other macronutrient intakes (g/day).

Conclusions:
Three-graded stratification of carbohydrate restriction according to baseline HbA1c levels may
provide T2DM patients with optimal objectives for carbohydrate restriction and prevent restriction from beingunnecessarily strict.


Source: Nutrition & Metabolism 2014, 11:33 doi:10.1186/1743-7075-11-33

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