HOW IMPORTANT IS A HIGH-CARBOHYDRATE, HIGH-FIBER DIET IN THE MANAGEMENT OF INSULIN-DEPENDENT DIABETES-MELLITUS

This study was designed to determine the importance of a low fat, high carbohydrate diet in modulating metabolic control in insulin-dependent diabetes mellitus (IDDM). Ten subjects (7 F, 3M) aged 21-40 yr with IDDM participated. Their insulin requirements ranged from 22-56 U daily and their duration of diabetes was 2-35 yr. Metabolic control was assessed before and after 2 wk on the experimental diet. The subjects weighed and recorded their food and liquid intake for 4 wk (2 wk on their usual diet and 2 wk on the experimental diet). Relative to their usual diet, the experimental diet was higher in carbohydrate (65 vs 46 % energy), higher in fiber (73 vs 22 g per day), lower in fat (11 % vs 36 % energy), contained less cholesterol (138 vs 314 mg) and had a higher P/S ratio (0.62 vs 0.36). There were no changes in body weight, insulin dose, hemoglobin (A1), or fasting glucose level in response to the 2 wk diet. Similarly, triglyceride and non-esterified fatty acid levels were unaffected by the diet, and there was no effect of the diet on the glycemic response to a standard breakfast (71 g carbohydrate, 17 g protein, 13 g fat). There was, however, a striking reduction in plasma cholesterol levels in response to the diet (4.67+/-0.30 vs 6.08+/-0.30). The HDL-cholesterol levels also fell (1.19+/-0.08 vs 1.54+/-0.08) and the total/HDL cholesterol ratio was unchanged. These data indicate that, in contrast to NIDDM, glycemic control in subjects with IDDM was unaffected by major changes in dietary composition. However, the cholesterol lowering effect of a high carbohydrate, hi-h fiber. low fat diet indicates its potential usefulness in reducing cardiovascular disease risk in IDDM.