Mayer S B, Jeffreys A S, Olsen M K, McDuffie J R, Feinglos M N, Yancy W S
Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Diabetes Obes Metab. 2014 Jan;16(1):90-3. doi: 10.1111/dom.12191. Epub 2013 Aug 29.
We analysed participants with type 2 diabetes (n = 46) within a larger weight loss trial (n = 146) who were randomized to 48 weeks of a low-carbohydrate diet (LCD; n = 22) or a low-fat diet + orlistat (LFD + O; n = 24). At baseline, mean body mass index (BMI) was 39.5 kg/m(2) (s.d. 6.5) and haemoglobin A1c (HbA1c) 7.6% (s.d. 1.3). Although the interventions reduced BMI similarly (LCD -2.4 kg/m(2) ; LFD + O -2.7 kg/m(2) , p = 0.7), LCD led to a relative improvement in HbA1c: -0.7% in LCD versus +0.2% in LFD + O [difference -0.8%, 95% confidence interval (CI) = -1.6, -0.02; p = 0.045]. LCD also led to a greater reduction in antiglycaemic medications using a novel medication effect score (MES) based on medication potency and total daily dose; 70.6% of LCD versus 30.4% LFD + O decreased their MES by ≥50% (p = 0.01). Lowering dietary carbohydrate intake demonstrated benefits on glycaemic control beyond its weight loss effects, while at the same time lowering antiglycaemic medication requirements.
我们在一项更大规模的减肥试验（n = 146）中分析了2型糖尿病患者（n = 46），这些患者被随机分为接受48周的低碳水化合物饮食（LCD；n = 22）或低脂饮食加奥利司他（LFD + O；n = 24）。基线时，平均体重指数（BMI）为39.5 kg/m²（标准差6.5），糖化血红蛋白（HbA1c）为7.6%（标准差1.3）。尽管两种干预措施使BMI降低的程度相似（LCD降低2.4 kg/m²；LFD + O降低2.7 kg/m²，p = 0.7），但LCD使HbA1c有相对改善：LCD组降低0.7%，而LFD + O组增加0.2%[差异为 -0.8%，95%置信区间（CI）= -1.6，-0.02；p = 0.045]。使用基于药物效力和每日总剂量的新型药物效应评分（MES），LCD还导致抗血糖药物的减少幅度更大；LCD组有70.6%的患者与LFD + O组30.4%的患者相比，其MES降低了≥50%（p = 0.01）。降低饮食中的碳水化合物摄入量除了具有减肥效果外，还对血糖控制有益，同时降低了对抗血糖药物的需求。
