Al Shaab Family Medicine Medical Center, Ministry of Health, Kuwait.
Nutrition. 2012 Oct;28(10):1016-21. doi: 10.1016/j.nut.2012.01.016. Epub 2012 Jun 5.
Effective diabetic management requires reasonable weight control. Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet (LCKD) in patients with type 2 diabetes after its long term administration. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage. Similar to the LCKD, the conventional low-calorie, high nutritional value diet is also used for weight loss. The purpose of this study was to understand the beneficial effects of LCKD compared with the low-calorie diet (LCD) in improving glycemia.
Three hundred and sixty-three overweight and obese participants were recruited from the Al-Shaab Clinic for a 24-wk diet intervention trial; 102 of them had type 2 diabetes. The participants were advised to choose LCD or LDKD, depending on their preference. Body weight, body mass index, changes in waist circumference, blood glucose level, changes in hemoglobin and glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, urea and creatinine were determined before and at 4, 8, 12, 16, 20, and 24 wk after the administration of the LCD or LCKD. The initial dose of some antidiabetic medications was decreased to half and some were discontinued at the beginning of the dietary program in the LCKD group. Dietary counseling and further medication adjustment were done on a biweekly basis.
The LCD and LCKD had beneficial effects on all the parameters examined. Interestingly, these changes were more significant in subjects who were on the LCKD as compared with those on the LCD. Changes in the level of creatinine were not statistically significant.
This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.
有效的糖尿病管理需要合理的体重控制。我们实验室的先前研究表明，低碳水化合物生酮饮食（LCKD）在长期服用后对 2 型糖尿病患者有益。此外，即使在血脂异常的肥胖患者中，它也能有利地改变心脏危险因素。这些研究表明，除了降低体重和改善血糖外，LCKD 还可以有效降低抗糖尿病药物的剂量。与 LCKD 类似，传统的低热量、高营养价值的饮食也用于减肥。本研究旨在了解 LCKD 与低热量饮食（LCD）改善血糖的有益效果。
从 Al-Shaab 诊所招募了 363 名超重和肥胖参与者参加为期 24 周的饮食干预试验；其中 102 人患有 2 型糖尿病。根据他们的喜好，建议参与者选择 LCD 或 LDKD。在开始 LCD 或 LCKD 治疗前以及治疗后 4、8、12、16、20 和 24 周时，测量体重、体重指数、腰围变化、血糖水平、血红蛋白和糖化血红蛋白变化、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、尿酸、尿素和肌酐。在 LCKD 组中，开始饮食计划时将一些抗糖尿病药物的初始剂量减少到一半，并停止使用一些药物。每两周进行一次饮食咨询和进一步的药物调整。
LCD 和 LCKD 对所有检查的参数均有有益影响。有趣的是，与 LCD 相比，LCKD 组的这些变化更为显著。肌酐水平的变化没有统计学意义。
本研究表明，生酮饮食对肥胖糖尿病患者比传统的 LCD 更有益。生酮饮食似乎可以改善血糖控制。因此，接受生酮饮食的糖尿病患者应接受严格的医疗监督，因为 LCKD 可以显著降低血糖水平。
