Aims/hypothesis: To evaluate the potential effectiveness of ‘carbohydrate days’ as a dietary intervention to overcome insulin resistance in type 2 diabetes.
Materials and Methods: Patients (n=14) with uncontrolled type 2 diabetes and insulin resistance as defined by a dosage of more than 1 IU/day*kg BW were consecutively enrolled in this prospective study. Primary outcomes were daily insulin requirement and mean blood glucose levels which were evaluated before, after, and 4 weeks after the intervention.
Results: All patients had a metabolic syndrome, 75% had microvascular and 57.1% macrovascular complications. Hospital setting and diabetes adapted diet alone led to improved glycemic control with a mean blood glucose 158±47 mg/dl. Intervention with two days of oatmeal diet further decreased mean blood glucose to 118±37 mg/dl (p<0.05). This was associated with a significant reduction of insulin dosage by 42.5% (before: 145±68.9 U/d, after 83±34.2 U/d, p<0.001) as well as a significant reduction (-26.4%, p<0.01) of serum leptin levels.After the four weeks outpatient period, insulin dosage remained significantly decreased (83±20.2 U/kg*d, p<0.01). Glycemic control was comparable (mean blood glucose141±20.78 mg/dl) to glucose levels within the hospital setting. Adiponectin levels increased significantly by 53.8% (p<0.05).
Conclusions: In this uncontrolled pilot study, hospital admission and diabetes adapted diet followed by oatmeal intervention achieved a ∼40% reduction of insulin dosage required to achieve controlled glucose levels. This effect was conserved after a 4 week outpatient phase with normal diet.
References
1
Stumvoll M, Goldstein BJ, Haeften TW van.
Type 2 diabetes: principles of pathogenesis and therapy.
Lancet.
2005;
365
1333-1346
2
American College of Endocrinology American Diabetes Association. Consensus statement on inpatient diabetes glycemic control .
A call to action. The ACE/ADA Task Force on Inpatient Diabetes.
Diab Care.
2006;
29
1955-1962
3
UK Prospective Diabetes Study (UKPDS) Group .
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet.
1998;
352
837-853
8
Kratzsch J, Berthold A, Lammert A, Reuter W, Keller E, Kiess W.
A rapid, quantitative immunofunctional assay for measuring human leptin.
Horm Res.
2002;
57
127-132
9
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V.
Uusitupa M, Finnish Diabetes Prevention Study Group
.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
N Engl J Med.
2001;
344
1343-1350
10
Qi L, Meigs JB, Liu S, Manson JE, Mantzoros CS, Hu FB.
Dietary fibers and glycemic load, obesity, and plasma adiponectin levels in women with type 2 diabetes.
Diab Care.
2006;
29
1501-1505
11
Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J. on behalf of the Finnish Diabetes Prevention Study Group .
Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.
Lancet.
2006;
368
1673-1679
14
Stefan N, Stumvoll M, Vozarova B, Weyer C, Funahashi T, Matsuzawa Y, Bogardus C, Tataranni A.
Plasma adiponectin and endogenous glucose production in humans.
Diab Care.
2003;
26
3315-3319
15
Tschritter O, Fritsche A, Thamer C, Haap M, Shirkavand F, Rahe S, Staiger H, Maerker E, Haring H, Stumvoll M.
Plasma adiponectin concentrations predict insulin sensitivity of both glucose and lipid metabolism.
Diabetes.
2003;
52
239-243
