Articles
15 March 2005

Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes

Publication: Annals of Internal Medicine
Volume 142, Number 6

Abstract

Background:

It is not known how a low-carbohydrate, high-protein, high-fat diet causes weight loss or how it affects blood glucose levels in patients with type 2 diabetes.

Objective:

To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control, insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.

Design:

Inpatient comparison of 2 diets.

Setting:

General clinical research center of a university hospital.

Patients:

10 obese patients with type 2 diabetes.

Intervention:

Usual diets for 7 days followed by a low-carbohydrate diet for 14 days.

Measurements:

Body weight, water, and composition; energy intake and expenditure; diet satisfaction; hemoglobin A1c; insulin sensitivity; 24-hour urinary ketone excretion; and plasma profiles of glucose, insulin, leptin, and ghrelin.

Results:

On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days). Mean 24-hour plasma profiles of glucose levels normalized, mean hemoglobin A1c decreased from 7.3% to 6.8%, and insulin sensitivity improved by approximately 75%. Mean plasma triglyceride and cholesterol levels decreased (change, −35% and −10%, respectively).

Limitations:

The study was limited by the short duration, small number of participants, and lack of a strict control group.

Conclusion:

In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 142Number 615 March 2005
Pages: 403 - 411

History

Published online: 15 March 2005
Published in issue: 15 March 2005

Keywords

Authors

Affiliations

Guenther Boden, MD
From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.
Karin Sargrad, MS, RD, CDE
From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.
Carol Homko, PhD, RN, CDE
From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.
Maria Mozzoli, BS
From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.
T. Peter Stein, PhD
From Temple University School of Medicine, Philadelphia, Pennsylvania, and University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, Stratford, New Jersey.
Acknowledgments: The authors thank the nurses of the General Clinical Research Center for help with the studies and for excellent patient care, Karen Kresge for technical assistance, and Constance Harris Crews for typing the manuscript.
Grant Support: By National Institutes of Health grants R01-AG15353, R01-DK58895, R01-HL0733267, R01-DK066003, and M01-RR-00349 (General Clinical Research Center branch of the National Center for Research Resources) and a Mentor-Based Training Grant from the American Diabetes Association (Dr. Boden).
Disclosures: None disclosed.
Corresponding Author: Guenther Boden, MD, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140.
Current Author Addresses: Drs. Boden and Homko and Ms. Mozzoli: Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140.
Ms. Sargrad: Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104.
Dr. Stein: University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, 1 Medical Center Drive, Stratford, NJ 08084.
Author Contributions: Conception and design: G. Boden, K. Sargrad.
Analysis and interpretation of the data: G. Boden, K. Sargrad, C. Homko, M. Mozzoli, T.P. Stein.
Drafting of the article: G. Boden.
Critical revision of the article for important intellectual content: G. Boden.
Final approval of the article: G. Boden.
Provision of study materials or patients: C. Homko, T.P. Stein.
Obtaining of funding: G. Boden.
Administrative, technical, or logistic support: C. Homko, M. Mozzoli.
Collection and assembly of data: K. Sargrad, C. Homko, M. Mozzoli.

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Guenther Boden, Karin Sargrad, Carol Homko, et al. Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes. Ann Intern Med.2005;142:403-411. [Epub 15 March 2005]. doi:10.7326/0003-4819-142-6-200503150-00006

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