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The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein^1,2,3

¹ From the Departments of Nutritional Sciences (TMSW, CM, RGJ, and LAL) and Statistics (ALG), University of Toronto, Toronto, Canada; the Department of Medicine, St Michael's Hospital, Toronto, Canada (TMSW, PWC, RGJ, and LAL); the Research Center Hôtel-Dieu de Montréal, University of Montréal, Montréal, Canada (J-LC and RR-L); the Department of Medicine, University of Sherbrooke, Québec, Canada (PM); the Department of Medicine, St Joseph's Health Center, University of Western Ontario, London, Canada (NWR); and the Department of Medicine, University of Alberta, Edmonton, Canada (EAR)

Background: The optimal source and amount of dietary carbohydrate for managing type 2 diabetes (T2DM) are unknown.

Objective: We aimed to compare the effects of altering the glycemic index or the amount of carbohydrate on glycated hemoglobin (HbA_1c), plasma glucose, lipids, and C-reactive protein (CRP) in T2DM patients.

Design: Subjects with T2DM managed by diet alone (n = 162) were randomly assigned to receive high-carbohydrate, high-glycemic-index (high-GI), high-carbohydrate, low-glycemic-index (low-GI), or low-carbohydrate, high-monounsaturated-fat (low-CHO) diets for 1 y.

Results: The high-GI, low-GI, and low-CHO diets contained, respectively, 47%, 52%, and 39% of energy as carbohydrate and 31%, 27%, and 40% of energy as fat; they had GIs of 63, 55, and 59, respectively. Body weight and HbA_1c did not differ significantly between diets. Fasting glucose was higher (P = 0.041), but 2-h postload glucose was lower (P = 0.010) after 12 mo of the low-GI diet. With the low-GI diet, overall mean triacylglycerol was 12% higher and HDL cholesterol 4% lower than with the low-CHO diet (P < 0.05), but the difference in the ratio of total to HDL cholesterol disappeared by 6 mo (time x diet interaction, P = 0.044). Overall mean CRP with the low-GI diet, 1.95 mg/L, was 30% less than that with the high-GI diet, 2.75 mg/L (P = 0.0078); the concentration with the low-CHO diet, 2.35 mg/L, was intermediate.

Conclusions: In subjects with T2DM managed by diet alone with optimal glycemic control, long-term HbA_1c was not affected by altering the GI or the amount of dietary carbohydrate. Differences in total:HDL cholesterol among diets had disappeared by 6 mo. However, because of sustained reductions in postprandial glucose and CRP, a low-GI diet may be preferred for the dietary management of T2DM.

Key Words: Humans • randomized controlled clinical trial • diet • carbohydrate • diabetes • monounsaturated fat

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