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The effect of a low-carbohydrate high-fat diet and ethnicity on daily glucose profile in type 2 diabetes determined by continuous glucose monitoring

  • Moran Blaychfeld-MagnaziEmail author
  • Naama Reshef
  • Taiba Zornitzki
  • Zecharia Madar
  • Hilla Knobler
Original Contribution

Abstract

Background and aims

Nutrition is an integral part of type 2 diabetes (T2DM) treatment, but the optimal macronutrient composition is still debated and previous studies have not addressed the role of ethnicity in dietary response. The current study aims were to compare the effect of short-term glycemic response to low-carbohydrate high-fat (LC-HF) diet vs. high-carbohydrate low-fat (HC-LF) diet using continuous glucose monitoring (CGM) and to evaluate the response of individuals with T2DM of Yemenite (Y-DM) and non-Yemenite origin (NY-DM).

Methods

Twenty T2DM males, ten Y-DM and ten NY-DM underwent meal tolerance test and indexes of insulin resistance and secretion were calculated. Subsequently, patients were connected to CGM to assess daily glycemic control and glucose variability in response to isocaloric HC-LF or LC-HF diet, receiving each diet for 2 days by providing prepared meals. Daily glucose levels, area under the glucose curve (G-AUC) and parameters of glucose variability [standard deviation (SD), mean amplitude of glycemic excursions (MAGE) and mean absolute glucose (MAG)] were evaluated.

Results

The LC-HF resulted in a significantly lower G-AUC (p < 0.001) and in lower variability parameters (p < 0.001) vs. the HC-LF diet. However, Y-DM showed less reduction in glucose variability indices upon diet-switching vs. NY-DM; MAGE decreased, respectively, by 69% vs. 89%, p = 0.043 and MAG by 34% vs. 45%, p = 0.007 in Y-DM compared to NY-DM.

Conclusions

These results suggest that LC-HF diet is effective in reducing glycemic fluctuation in T2DM and that ethnicity may have a role in the response to dietary regime.

Keywords

Diabetes Diet High carbohydrate Low carbohydrate Glycemic variability Ethnicity 

Abbreviations

ADA

American Diabetes Association

AUC

Area under the curve

BMI

Body mass index

CGM

Continuous glucose monitor

G-AUC

Area under the glucose curve

GIP

Gastric inhibitory polypeptide

GLP1

Glucagon-like peptide-1

HbA1c

Hemoglobin A1c

HC

High carbohydrate

HC-LF

High carbohydrate low fat

LC

Low carbohydrate

LC-HF

Low carbohydrate high fat

MAG

Mean absolute glucose

MAGE

Mean amplitude of glycemic excursions

MUFA

Monounsaturated fat

Y-DM

Yemenite diabetes mellitus

NY-DM

Non-Yemenite diabetes mellitus

PUFA

Polyunsaturated fat

SAFA

Saturated fat

SD

Standard deviation

T2DM

Type 2 diabetes mellitus

Notes

Acknowledgements

The authors wish to thank Ronit Harris for the statistical analysis.

Author contributions

MBM and NR designed the research, conducted the research, analyzed the data and wrote the paper. TZ contributed to the design conduction and analysis of the data. ZM designed the research, analyzed the data, reviewed/edited manuscript. HK designed the research, analyzed the data, and wrote the manuscript. All authors read and approved the final manuscript.

Funding

This work was supported by the E’ELE Betamar organization Clinical Trial Registry: WHO—http://www.who.int/ictrp/unambiguous_identification/utn/en/ The Universal Trial Number (UTN): U1111-1124-0079.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Diabetes, Metabolic and Endocrinology Institute, Kaplan Medical CenterHebrew University Medical SchoolRehovotIsrael
  2. 2.Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and EnvironmentHebrew UniversityJerusalemIsrael
  3. 3.Clinical Research Unit, Pavilion 16Kaplan Medical CenterRehovotIsrael

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