There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .
The insulin resistance phenotype (muscle or liver) interacts with the type of diet to determine changes in disposition index after 2 years of intervention: the CORDIOPREV-DIAB randomised clinical trial
Abstract Aims /hypothesisThe aim of the study was to determine whether basal insulin resistance ( IR ) phenotype ( muscle and /or liver ) determines the effect of long-term consumption of a Mediterranean diet or a low-fat diet on tissue-specific IR and beta cell function . Methods The study was performed in 642 patients included in The effect of an olive oil rich Mediterranean diet on type 2 diabetes mellitus risk and incidence study ( CORDIOPREV-DIAB ) . A total of 327 patients were r and omised to a Mediterranean diet ( 35 % fat ; 22 % from monounsaturated fatty acids ) and 315 to a low-fat diet ( < 28 % fat ) . At baseline , the patients were classified into four phenotypes according to the type of IR : ( 1 ) no IR ; ( 2 ) muscle IR ; ( 3 ) liver IR ; ( 4 ) muscle + liver IR . The hepatic insulin resistance index ( HIRI ) , muscular insulin sensitivity index ( MISI ) and disposition index were analysed at baseline and after 2 years of follow-up . Results At baseline , 322 patients presented  no IR , 106 presented muscle IR , 109 presented liver IR , and 105 presented muscle + liver IR . With both dietary interventions , HIRI decreased in all patients ( p < 0.001 ) and MISI increased in muscle IR and muscle + liver IR patients ( p < 0.01 ) . Long-term intake of the Mediterranean diet increased the disposition index and insulinogenic index in the muscle IR patients ( p = 0.042 and p = 0.044 , respectively ) and the disposition index in the muscle + liver IR patients ( p = 0.048 ) , whereas the low-fat diet increased the disposition index in the liver IR patients ( p = 0.017 ) . Conclusions /interpretationAlthough both diets improve insulin sensitivity , there are differences based on basal IR phenotypes . Moreover , according to insulinogenic and disposition index data , a low-fat diet might be more beneficial to patients with liver IR , whereas patients with muscle IR and muscle + liver IR might benefit more from a Mediterranean diet . Trial registration Clinical Trials.gov NCT00924937 Funding The study was supported by the Ministerio de Economia y Competitividad ( AGL2012/39615 ) and by the Ministerio de Ciencia e Innovacion ( PIE14/00005 and PI13/00023
There is low to high ( majority moderate ) certainty for small improvements of unclear clinical importance in plasma glucose , triglycerides , and HDL concentrations favoring low-carbohydrate food at half of the prespecified time points .
There was little to no difference in LDL concentration or any of the secondary outcomes ( body weight , waist circumference , blood pressure , quality of life ) in response to either of the diets ( very-low- to high-certainty evidence ) .
Conclusions Currently available data provide low- to moderate-certainty evidence that dietary carbohydrate restriction to a maximum of 40 % yields slightly better metabolic control of uncertain clinical importance than reduction in fat to a maximum of 30 % in people with T2D .
Background It remains uncertain which diet is best for people with type 2 diabetes ( T2D ) .
Objective We compared the effects of dietary carbohydrate restriction with fat restriction on markers of metabolic syndrome and quality of life in people with T2D .