Jenkins David J A, Kendall Cyril W C, McKeown-Eyssen Gail, Josse Robert G, Silverberg Jay, Booth Gillian L, Vidgen Edward, Josse Andrea R, Nguyen Tri H, Corrigan Sorcha, Banach Monica S, Ares Sophie, Mitchell Sandy, Emam Azadeh, Augustin Livia S A, Parker Tina L, Leiter Lawrence A
Clinical Nutrition and Risk Factor Modification Center, St Michael's Hospital, Toronto, Ontario, Canada.
JAMA. 2008 Dec 17;300(23):2742-53. doi: 10.1001/jama.2008.808.
Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations.
To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes.
DESIGN, SETTING, AND PARTICIPANTS: A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007.
High-cereal fiber or low-glycemic index dietary advice.
Absolute change in glycated hemoglobin A(1c) (HbA(1c)), with fasting blood glucose and cardiovascular disease risk factors as secondary measures.
In the intention-to-treat analysis, HbA(1c) decreased by -0.18% absolute HbA(1c) units (95% confidence interval [CI], -0.29% to -0.07%) in the high-cereal fiber diet compared with -0.50% absolute HbA(1c) units (95% CI, -0.61% to -0.39%) in the low-glycemic index diet (P < .001). There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL (95% CI, -0.9 to 0.5 mg/dL) in the high-cereal fiber diet (P = .005). The reduction in dietary glycemic index related positively to the reduction in HbA(1c) concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = -0.19, P = .009).
In patients with type 2 diabetes, 6-month treatment with a low-glycemic index diet resulted in moderately lower HbA(1c) levels compared with a high-cereal fiber diet. Trial Registration clinicaltrials.gov identifier: NCT00438698.
使用抗高血糖药物改善血糖控制的临床试验并未显示出预期的心血管益处。低血糖指数饮食可能改善2型糖尿病患者的血糖控制和心血管危险因素，但由于试验局限性，关于其有效性的争论仍在继续。
测试低血糖指数饮食对2型糖尿病患者血糖控制和心血管危险因素的影响。
设计、地点和参与者：在加拿大一所大学医院研究中心进行的一项随机平行研究设计，210名接受抗高血糖药物治疗的2型糖尿病患者通过报纸广告招募，并在2004年9月16日至2007年5月22日期间随机分配接受两种饮食治疗中的一种，每种治疗为期6个月。
高谷物纤维或低血糖指数饮食建议。
糖化血红蛋白A1c（HbA1c）的绝对变化，空腹血糖和心血管疾病危险因素作为次要指标。
在意向性分析中，高谷物纤维饮食组的HbA1c绝对降低了0.18% HbA1c单位（95%置信区间[CI]，-0.29%至-0.07%），而低血糖指数饮食组的HbA1c绝对降低了0.50% HbA1c单位（95% CI，-0.61%至-0.39%）（P <.001）。低血糖指数饮食组的高密度脂蛋白胆固醇增加了1.7mg/dL（95% CI，0.8 - 2.6mg/dL），而高谷物纤维饮食组的高密度脂蛋白胆固醇降低了0.2mg/dL（95% CI，-0.9至0.5mg/dL）（P =.005）。饮食血糖指数的降低与HbA1c浓度的降低呈正相关（r = 0.35，P <.001），与高密度脂蛋白胆固醇的增加呈负相关（r = -0.19，P =.009）。
在2型糖尿病患者中，与高谷物纤维饮食相比，低血糖指数饮食6个月的治疗导致HbA1c水平适度降低。试验注册 clinicaltrials.gov标识符：NCT00438698。
