A Low-Carbohydrate/High-Fat Diet Improves Glucoregulation in Type 2 Diabetes Mellitus by Reducing Postabsorptive Glycogenolysis
- Gideon Allick 1 ,
- Peter H. Bisschop 1 ,
- Mariette T. Ackermans,
- Erik Endert,
- Alfred J. Meijer,
- Folkert Kuipers,
- Hans P. Sauerwein and
- Johannes A. Romijn
- Author Affiliations
- Departments of Endocrinology and Metabolism (G.A., P.H.B., H.P.S.), Clinical Chemistry (M.T.A., E.E.), Laboratory of Endocrinology, and Biochemistry (A.J.M.), Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; Center for Liver, Digestive, and Metabolic Diseases (F.K.), Department of Pediatrics, University Hospital Groningen, 9713 GZ Groningen, The Netherlands; and Department of Endocrinology (P.H.B., J.A.R.), Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Address all correspondence and requests for reprints to: G. Allick, Department of Endocrinology and Metabolism (F5), Academic Medical Center, University of Amsterdam, P.O. BOX 22660, 1100 DD Amsterdam, The Netherlands. E-mail: g.allick@amc.uva.nl.
Abstract
The aim of this study was to examine the mechanisms by which dietary carbohydrate and fat modulate fasting glycemia. We compared the effects of an eucaloric high-carbohydrate (89% carbohydrate) and high-fat (89% fat) diet on fasting glucose metabolism and insulin sensitivity in seven obese patients with type 2 diabetes using stable isotopes and euglycemic hyperinsulinemic clamps. At basal insulin levels glucose concentrations were 148 ± 11 and 123 ± 11 mg/dl (8.2 ± 0.6 and 6.8 ± 0.6 mmol/liter) on the high-carbohydrate and high-fat diet, respectively (P < 0.001), with insulin concentrations of 12 ± 2 and 10 ± 1 μIU/ml (82 ± 11 and 66 ± 10 pmol/liter) (P = 0.08). Glucose production was higher on the high-carbohydrate diet (1.88 ± 0.06 vs. 1.55 ± 0.05 mg/kg·min (10.44 ± 0.33 vs. 8.61 ± 0.28 μmol/kg·min) (P < 0.001) because of higher glycogenolysis. Gluconeogenic rates were not different between the diets. During the use of hyperinsulinemic euglycemic clamps, insulin-mediated suppression of glucose production and stimulation of glucose disposal were not different between the diets. Free fatty concentrations were suppressed by 89 and 62% (P < 0.0001) on the high-carbohydrate and high-fat diet, respectively.
We conclude that short-term variations in dietary carbohydrate to fat ratios affect basal glucose metabolism in people with type 2 diabetes merely through modulation of the rate of glycogenolysis, without affecting insulin sensitivity of glucose metabolism.
