Weight Loss, Glycemic Control, and Cardiovascular Disease Risk Factors in Response to Differential Diet Composition in a Weight Loss Program in Type 2 Diabetes: A Randomized Controlled Trial

  1. Nancy E. Sherwood2
  1. 1Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, La Jolla, CA
  2. 2HealthPartners Research Institute for Education and Research and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
  1. Corresponding author: Cheryl L. Rock, clrock{at}


OBJECTIVE To test whether a weight loss program promotes greater weight loss, glycemic control, and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake.

RESEARCH DESIGN AND METHODS This randomized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling, with prepackaged foods in a planned menu during the initial phase, or to usual care (UC; two weight loss counseling sessions and monthly contacts).

RESULTS Relative weight loss was 7.4% (95% CI, 5.7–9.2%), 9.0% (7.1–10.9%), and 2.5% (1.3–3.8%) for the lower fat, lower carbohydrate, and UC groups (P < 0.001 intervention effect). Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year (fasting glucose 141 [95% CI, 133–149] vs. 159 [144–174] mg/dL, P = 0.010; hemoglobin A1c 6.9% [6.6–7.1%] vs. 7.5% [7.1–7.9%] or 52 [49–54] vs. 58 [54–63] mmol/mol, P = 0.001; triglycerides 148 [134–163] vs. 204 [173–234] mg/dL, P < 0.001). The lower versus higher carbohydrate groups maintained lower hemoglobin A1c (6.6% [95% CI, 6.3–6.8%] vs. 7.2% [6.8–7.5%] or 49 [45–51] vs. 55 [51–58] mmol/mol) at 1 year (P = 0.008).

CONCLUSIONS The weight loss program resulted in greater weight loss and improved glycemic control in type 2 diabetes.

  • Received December 11, 2013.
  • Accepted February 16, 2014.

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