METABOLIC AND DIETARY VARIABLES ASSOCIATED WITH GLYCEMIC CONTROL IN PATIENTS WITH RECENTLY DIAGNOSED TYPE-II DIABETES-MELLITUS

We studied 86 obese patients with recently diagnosed Type 2 diabetes who received the same basic education during the first three months and after that either a 12-month intensified diet and exercise or conventional diet education. The principal aim of the study was to examine the effects of these treatment modes on glucose tolerance and insulin secretion and to elucidate the variables associated with improved glycaemic control. The intensified education resulted in a better glycaemic control than the conventional one (fasting blood glucose 6.2+/-0.3 vs 1.5+/-0.3 mmol/l, p<0.01; glycated haemoglobin Ale 6.6+/-0.2 vs 7.5+/-0.3%, p<0.05). Fasting plasma insulin and C-peptide concentrations decreased significantly in both groups (fasting plasma insulin (mean+/-SEM) 23.6+/-1.6 vs 17.9+/-1.7 mU/l in the intervention group 0 vs 15 months, and 25.1+/-3.2 vs 20.6+/-2.1 mU/l in the conventional treatment group, respectively). Increments of plasma insulin and C-peptide responses to the oral glucose load increased in subjects who had the greatest decrease in fasting blood glucose level. After combining the treatment groups, the variables associated with improved fasting blood glucose by multiple regression analysis were a high initial level of fasting blood glucose (p<0.001), weight reduction (p<0.001), a high initial level of fasting plasma insulin (p<0.001), an increased response of plasma insulin to the oral glucose load (p<0.001), a low intake of saturated fatty acids (p<0.05) and a decreased proportion of the palmitic acid in serum triglycerides (p<0.01). This model explained 73% of the decrease in fasting blood glucose level. In conclusion, besides weight loss a moderate intake of saturated fatty acids was associated with the improved glycaemic control of patients with Type 2 diabetes possibly through improved insulin sensitivity.