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

Guenther Boden, MD; Karin Sargrad, MS, RD, CDE; Carol Homko, PhD, RN, CDE; Maria Mozzoli, BS; and T. Peter Stein, PhD
[+] Article and Author Information

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).

Potential Financial Conflicts of Interest: 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.


Ann Intern Med. 2005;142(6):403-411. doi:10.7326/0003-4819-142-6-200503150-00006
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Figures

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Figure 1.
Daily body weights and energy intakes (top) and urinary ketone body excretion (bottom).

Data are from 10 patients with type 2 diabetes while on their usual high-carbohydrate, high-protein, high-fat diet (days 1 to 7) and while on a low-carbohydrate, high-protein, high-fat diet (days 8 to 21). Values are means ± SE.

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Figure 2.
Profiles of 24-hour plasma glucose, insulin, leptin, and ghrelin.

Data are from 9 patients (1 patient declined to participate) with type 2 diabetes obtained on day 7 on their usual high-carbohydrate, high-protein, high-fat diet and after 2 weeks (day 21) on a low-carbohydrate diet. Individual values and means of the areas under the curves (AUCs) of these profiles are shown on the right. During the low-carbohydrate diet, insulin doses were decreased in 2 patients, metformin and thiazolidinediones doses were decreased in 1 patient each, and sulfonylureas were discontinued in 1 patient. Values are means ± SE.

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Figure 3.
Plasma glucose and insulin levels and glucose infusion rates (GIR) needed to maintain euglycemia, rates of glucose disappearance (GRd) and endogenous glucose production (EGP).

Data were obtained during euglycemic hyperinsulinemic clamping performed in 10 obese patients with type 2 diabetes before (admission); after 1 week of their usual high-carbohydrate, high-protein, high-fat diet (before); and after 2 weeks of a strict low-carbohydrate diet (after). Glucose infusion rates are shown uncorrected and corrected for differences in clamp insulin levels (ΔGIR/ΔIRI). Rates of glucose disappearance and EGP are shown corrected for differences in basal rates and clamp insulin levels (ΔGRd /ΔIRI and ΔEGP/ΔIRI, respectively). IRI = immunoreactive insulin.

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Summary for Patients

Short-Term Effects of Low-Carbohydrate Diet Compared with Usual Diet in Obese Patients with Type 2 Diabetes

The summary below is from the full report titled “Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes.” It is in the 15 March 2005 issue of Annals of Internal Medicine (volume 142, pages 403-411). The authors are G. Boden, K. Sargrad, C. Homko, M. Mozzoli, and T.P. Stein.

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