Dietary restriction, in conjunction with the anti-diabetic drugs metformin and liraglutide, is effective in patients with advanced diabetes.
Diabetes and obesity go hand in hand. The epidemic is rampant globally, engulfing both developed and developing countries. Westernized eating habits and lifestyle are the factors predominantly held responsible for this. Diets with low fat content and high amounts of carbohydrates are recommended by official guidelines although these have never been proved effective. A diet restricted in fat content and enriched in carbohydrates have not shown any effect in reducing heart disease connected with diabetes.
AdvertisementReducing weight is an effective intervention to treat type 2 diabetes but this is difficult to achieve. Diabetic patients are often put on insulin and this cause an increase in body weight. Increased body weight further elevates the required doses of insulin injections. High insulin doses have also known to produce poor metabolic results.
Carbohydrate-rich diet is not good for the heart either. It results in raised levels of triglycerides and small dense LDL (bad-cholesterol) and low levels of HDL (good-cholesterol). Such an altered lipid profile increases the risk of heart diseases. It would therefore be wiser to adhere to a carbohydrate-restricted diet rather than the standard low fat-high carbohydrate intervention.
Liraglutide belongs to the recently introduced group of antidiabetic drugs called GLP-1 analogues. GLP-1 analogues facilitate weight reduction by inducing satiety. They also avoid hypoglycemia, a common side effect of anti-diabetic medications. Another drug called metformin is commonly used orally to treat type 2 diabetes.
Forty patients with advanced diabetes, who failed to improve even on two oral anti-diabetic drugs or insulin treatment, were enrolled in a recent 24-weeks trial. The ongoing treatment was modified. Insulin and the oral anti-diabetic drugs (except metformin) were stopped. The patients were put on a carbohydrate-restricted diet and a combination of metformin and liraglutide. They were reviewed during follow-up visits at one, two, three and six months.
Thirty-five patients completed the study. A drop in HbA1c (an important marker of the diabetic status, values lower than 7.0% are good) and body weight were noticed in most of the participants. Patients were all satisfied with the treatment. Lipid profile remained largely unaffected.
The trial was designed as proof-of-concept study without control group. This may also be viewed as a limitation of the study. However the study finding brings good news to diabetic patients since it enables reduction in medications. Patients with short duration of diabetes are benefited better. Low carb-diets alone or in conjunction with metformin may be used to treat newly diagnosed diabetes type 2 showing HbA1c values of around 9%.
Patients with long lasting diabetes whose standard treatments failed to produce metabolic control could now possibly switch to this alternative diet regimen, after consulting their physicians.
1. Carbohydrate restricted diet in conjunction with metformin and liraglutide is an effective treatment in patients with deteriorated type 2 diabetes mellitus: Proof-of-concept study
Nutrition & Metabolism 2011, 8:92 doi:10.1186/1743-7075-8-92