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The effect of a low-carbohydrate high-fat diet and ethnicity on daily glucose profile in type 2 diabetes determined by continuous glucose monitoring

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Abstract

Background and aims

Nutrition is an integral part of type 2 diabetes (T2DM) treatment, but the optimal macronutrient composition is still debated and previous studies have not addressed the role of ethnicity in dietary response. The current study aims were to compare the effect of short-term glycemic response to low-carbohydrate high-fat (LC-HF) diet vs. high-carbohydrate low-fat (HC-LF) diet using continuous glucose monitoring (CGM) and to evaluate the response of individuals with T2DM of Yemenite (Y-DM) and non-Yemenite origin (NY-DM).

Methods

Twenty T2DM males, ten Y-DM and ten NY-DM underwent meal tolerance test and indexes of insulin resistance and secretion were calculated. Subsequently, patients were connected to CGM to assess daily glycemic control and glucose variability in response to isocaloric HC-LF or LC-HF diet, receiving each diet for 2 days by providing prepared meals. Daily glucose levels, area under the glucose curve (G-AUC) and parameters of glucose variability [standard deviation (SD), mean amplitude of glycemic excursions (MAGE) and mean absolute glucose (MAG)] were evaluated.

Results

The LC-HF resulted in a significantly lower G-AUC (p < 0.001) and in lower variability parameters (p < 0.001) vs. the HC-LF diet. However, Y-DM showed less reduction in glucose variability indices upon diet-switching vs. NY-DM; MAGE decreased, respectively, by 69% vs. 89%, p = 0.043 and MAG by 34% vs. 45%, p = 0.007 in Y-DM compared to NY-DM.

Conclusions

These results suggest that LC-HF diet is effective in reducing glycemic fluctuation in T2DM and that ethnicity may have a role in the response to dietary regime.

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Abbreviations

ADA:

American Diabetes Association

AUC:

Area under the curve

BMI:

Body mass index

CGM:

Continuous glucose monitor

G-AUC:

Area under the glucose curve

GIP:

Gastric inhibitory polypeptide

GLP1:

Glucagon-like peptide-1

HbA1c :

Hemoglobin A1c

HC:

High carbohydrate

HC-LF:

High carbohydrate low fat

LC:

Low carbohydrate

LC-HF:

Low carbohydrate high fat

MAG:

Mean absolute glucose

MAGE:

Mean amplitude of glycemic excursions

MUFA:

Monounsaturated fat

Y-DM:

Yemenite diabetes mellitus

NY-DM:

Non-Yemenite diabetes mellitus

PUFA:

Polyunsaturated fat

SAFA:

Saturated fat

SD:

Standard deviation

T2DM:

Type 2 diabetes mellitus

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Acknowledgements

The authors wish to thank Ronit Harris for the statistical analysis.

Funding

This work was supported by the E’ELE Betamar organization Clinical Trial Registry: WHO—http://www.who.int/ictrp/unambiguous_identification/utn/en/ The Universal Trial Number (UTN): U1111-1124-0079.

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Authors and Affiliations

  1. Diabetes, Metabolic and Endocrinology Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel

    Moran Blaychfeld-Magnazi, Naama Reshef, Taiba Zornitzki & Hilla Knobler

  2. Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University, Jerusalem, Israel

    Moran Blaychfeld-Magnazi & Zecharia Madar

  3. Clinical Research Unit, Pavilion 16, Kaplan Medical Center, Pasternak Rd, POB 1, 76100, Rehovot, Israel

    Moran Blaychfeld-Magnazi

Authors
  1. Moran Blaychfeld-Magnazi
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  2. Naama Reshef
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  3. Taiba Zornitzki
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  4. Zecharia Madar
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  5. Hilla Knobler
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Contributions

MBM and NR designed the research, conducted the research, analyzed the data and wrote the paper. TZ contributed to the design conduction and analysis of the data. ZM designed the research, analyzed the data, reviewed/edited manuscript. HK designed the research, analyzed the data, and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Moran Blaychfeld-Magnazi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Moran Blaychfeld-Magnazi and Naama Reshef are co-first authors.

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Blaychfeld-Magnazi, M., Reshef, N., Zornitzki, T. et al. The effect of a low-carbohydrate high-fat diet and ethnicity on daily glucose profile in type 2 diabetes determined by continuous glucose monitoring. Eur J Nutr 59, 1929–1936 (2020). https://doi.org/10.1007/s00394-019-02043-z

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  • DOI: https://doi.org/10.1007/s00394-019-02043-z

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