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294: The effect of a low glycemic index diet on markers of cardiovascular disease risk in type 2 diabetes
Multiple Risk Factors in Cardiovascular Disease—Abstracts
inflammatory markers may be due to glycemic control. Sitagliptin may thus be beneficial in decreasing the inflammatory components in type 2 diabetic patients with atherosclerosis.
Funding: The Canadian Institutes of Health Research, Ottawa, Canada; The Barilla Group, Parma, Italy
Funding: none
295
294 THE EFFECT OF A LOW GLYCEMIC INDEX DIET ON MARKERS OF CARDIOVASCULAR DISEASE RISK IN TYPE 2 DIABETES C.W.C. Kendall1,2, A.R. Josse1,2, J.M.W. Wong1,2, J. Sievenpiper1,2, D.J.A. Jenkins1,2. 1Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada, 2 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Objective: To determine the effect of a low glycemic index (GI) diet on markers of long-term glycemic control and coronary heart disease (CHD) risk in subjects with type 2 diabetes taking oral hypoglycemic agents. Methods: 210 nonobese subjects with type 2 diabetes and baseline HbA1c between 6.5-8%, were randomized to a 6 month study of parallel design. Subjects were instructed to follow either a high cereal fibernormal GI diet (mean GI=80; control) or a low GI diet (mean GI<70; test) with a comparable fiber content to the control. Results: For the 155 subjects who completed the study, the low GI versus the high fiber diet resulted in significant reductions in HbA1c by 5.8% (P<0.001), triglycerides by 7.2% (P<0.001), diastolic blood pressure by 1.2% (P=0.049) and a rise in HDL-C by 6.6% (P=0.004). Weight was non significantly lower by 1.0% (P=0.094). No significance difference was seen in C-reactive protein. Microalbuminemia was also reduced on the low GI diet in those with significant losses at baseline as a marker of CHD risk, but no treatment difference was seen in creatinine clearance. Conclusions: In subjects with type 2 diabetes on oral hypoglycemic agents, a low GI diet may not only be beneficial for long-term glycemic control, but may also improve other CHD risk factors.
S138
FRUCTOSE'S EFFECT ON LIPIDS DEPENDS ON THE REFERENCE CARBOHYDRATE, DOSE, AND FOLLOW-UP IN TYPE 2 DIABETES: A META-ANALYSIS OF CONTROLLED TRIALS J.L. Sievenpiper1, A.J. Carleton1, H.Y. Jiang1, R.J. De Souza2, C.W. Kendall1, D.J. Jenkins1. 1 St. Michael's Hospital and University of Toronto, Toronto, ON, Canada, 2Harvard School of Public Health, Boston, MA, USA Objective: Diabetes associations continue to discourage added fructose at high intakes, as it may aggravate lipids. To clarify this effect, we conducted a meta-analysis. Methods: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for controlled trials of =7d investigating the effect of isocaloric fructose exchange for carbohydrate on triglycerides (TG) and total (TC), LDL (LDL-C) and HDL (HDL-C) cholesterol in type 2 (DM2) and type 1 (DM1) diabetes. We used a random-effects model with inverse variance weighting. Results: Fourteen trials (n=286 DM2, n=110 DM1) met the eligibility criteria. Fructose exchange for carbohydrate did not affect TG, TC, LDL-C, or HDL-C. Significant heterogeneity was detected for all estimates except LDL-C and HDL-C. Subgroup analyses for TG in DM2 showed that fructose exchange for carbohydrate raised TG only when the reference carbohydrate was starch (0.18mmol/L, 95% CI 0.00-0.22), dose was >65g/d (0.17, 0.07-0.27), and follow-up was £4wk (0.11, 0.02-0.21). Piece-wise meta-regression confirmed the dose threshold of >65g/d (r2=0.80, P=0.042). Removal of one study in sensitivity analyses eliminated the heterogeneity for TG in DM1 without altering the null effect. Heterogeneity remained unexplained for TC. Conclusions: Pooled analyses demonstrated a TG raising effect of isocaloric fructose exchange for carbohydrate in DM2 only at doses >65g/d and follow-up £4wk or for starch at any dose and follow-up. No effect was shown for TG in DM1 and LDL-C or HDL-C in DM2 or DM1. The null effect for TC was complicated by serious heterogeneity. Future guidelines should consider these distinctions.
inflammatory markers may be due to glycemic control. Sitagliptin may thus be beneficial in decreasing the inflammatory components in type 2 diabetic patients with atherosclerosis.
Funding: The Canadian Institutes of Health Research, Ottawa, Canada; The Barilla Group, Parma, Italy
Funding: none
295
294 THE EFFECT OF A LOW GLYCEMIC INDEX DIET ON MARKERS OF CARDIOVASCULAR DISEASE RISK IN TYPE 2 DIABETES C.W.C. Kendall1,2, A.R. Josse1,2, J.M.W. Wong1,2, J. Sievenpiper1,2, D.J.A. Jenkins1,2. 1Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada, 2 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Objective: To determine the effect of a low glycemic index (GI) diet on markers of long-term glycemic control and coronary heart disease (CHD) risk in subjects with type 2 diabetes taking oral hypoglycemic agents. Methods: 210 nonobese subjects with type 2 diabetes and baseline HbA1c between 6.5-8%, were randomized to a 6 month study of parallel design. Subjects were instructed to follow either a high cereal fibernormal GI diet (mean GI=80; control) or a low GI diet (mean GI<70; test) with a comparable fiber content to the control. Results: For the 155 subjects who completed the study, the low GI versus the high fiber diet resulted in significant reductions in HbA1c by 5.8% (P<0.001), triglycerides by 7.2% (P<0.001), diastolic blood pressure by 1.2% (P=0.049) and a rise in HDL-C by 6.6% (P=0.004). Weight was non significantly lower by 1.0% (P=0.094). No significance difference was seen in C-reactive protein. Microalbuminemia was also reduced on the low GI diet in those with significant losses at baseline as a marker of CHD risk, but no treatment difference was seen in creatinine clearance. Conclusions: In subjects with type 2 diabetes on oral hypoglycemic agents, a low GI diet may not only be beneficial for long-term glycemic control, but may also improve other CHD risk factors.
S138
FRUCTOSE'S EFFECT ON LIPIDS DEPENDS ON THE REFERENCE CARBOHYDRATE, DOSE, AND FOLLOW-UP IN TYPE 2 DIABETES: A META-ANALYSIS OF CONTROLLED TRIALS J.L. Sievenpiper1, A.J. Carleton1, H.Y. Jiang1, R.J. De Souza2, C.W. Kendall1, D.J. Jenkins1. 1 St. Michael's Hospital and University of Toronto, Toronto, ON, Canada, 2Harvard School of Public Health, Boston, MA, USA Objective: Diabetes associations continue to discourage added fructose at high intakes, as it may aggravate lipids. To clarify this effect, we conducted a meta-analysis. Methods: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for controlled trials of =7d investigating the effect of isocaloric fructose exchange for carbohydrate on triglycerides (TG) and total (TC), LDL (LDL-C) and HDL (HDL-C) cholesterol in type 2 (DM2) and type 1 (DM1) diabetes. We used a random-effects model with inverse variance weighting. Results: Fourteen trials (n=286 DM2, n=110 DM1) met the eligibility criteria. Fructose exchange for carbohydrate did not affect TG, TC, LDL-C, or HDL-C. Significant heterogeneity was detected for all estimates except LDL-C and HDL-C. Subgroup analyses for TG in DM2 showed that fructose exchange for carbohydrate raised TG only when the reference carbohydrate was starch (0.18mmol/L, 95% CI 0.00-0.22), dose was >65g/d (0.17, 0.07-0.27), and follow-up was £4wk (0.11, 0.02-0.21). Piece-wise meta-regression confirmed the dose threshold of >65g/d (r2=0.80, P=0.042). Removal of one study in sensitivity analyses eliminated the heterogeneity for TG in DM1 without altering the null effect. Heterogeneity remained unexplained for TC. Conclusions: Pooled analyses demonstrated a TG raising effect of isocaloric fructose exchange for carbohydrate in DM2 only at doses >65g/d and follow-up £4wk or for starch at any dose and follow-up. No effect was shown for TG in DM1 and LDL-C or HDL-C in DM2 or DM1. The null effect for TC was complicated by serious heterogeneity. Future guidelines should consider these distinctions.