Dietary Interventions for Type 2 Diabetes

Richard K. Bernstein, MD, FACE, FACN, CWS, FCCWS

Director Emeritus, Peripheral Vascular Disease Clinic
Jacobi Medical Center
Albert Einstein College of Medicine
Bronx, NY
Website: http://www.askdrbernstein.net/

Nutritional intervention is the cornerstone of type 2 diabetes (T2DM) management. However, low-fat, high-carbohydrate diets, while widely prescribed, have limited success.¹ Carbohydrate restriction is increasingly viewed as an alternative dietary strategy. Accumulated data show that such diets are at least as effective as low-fat diets for weight loss and glycemic control.¹ Most recently, a proof-of-concept study evaluated carbohydrate restriction in patients with A1C levels >7.5% while on pharmacologic therapy.² Investigators switched study subjects to metformin plus liraglutide and counseled patients to ingest <20 g of carbohydrates per day with no restriction on total calories. After 8 weeks patients were allowed to add small amounts of carbohydrates for breakfast. At study end 71% of patients had A1C levels <7% and the average weight loss was 10%. Given that nutritional counseling must be individualized, carbohydrate restriction broadens the range of available options to clinicians.

References

Accurso A, Bernstein RK, Dahlqvist A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond). 2008;5:9.
Müller JE, Sträter-Müller D, Marks HJ, et al. Carbohydrate restricted diet in conjunction with metformin and liraglutide is an effective treatment in patients with deteriorated type 2 diabetes mellitus: Proof-of-concept study. Nutr Metab (Lond). 2011;8:92.

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