Diabetes Type 1 and 2

DM: Carbohydrate Amount (2014)

• Intervention
  In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on CVD risk factors (lipids or blood pressure)?

  • Conclusion

    Two studies (one in adults with well-controlled type 1 diabetes; another in adults with well-controlled type 2 diabetes) regarding the relationship of differing amounts of carbohydrate (39% to 57% of energy), independent of weight loss, on CVD risk factors reported no significant effect on total cholesterol, LDL-cholesterol or blood pressure levels. Research regarding differing amounts of carbohydrate reports no significant effect on HDL-cholesterol and triglyceride levels in adults with type 1 diabetes, while decreased HDL-cholesterol and increased triglyceride levels were reported when consuming a higher-carbohydrate/lower-glycemic index/lower-fat diet in adults with type 2 diabetes.

    Subjects did not have or were not described as having any disorders of lipid metabolism or hypertension. Additional long-term studies are needed to ascertain the relationship of differing amounts of carbohydrate, independent of weight loss, on lipid profile in adults with diabetes, especially those with disorders of lipid metabolism and hypertension.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on CVD risk factors (lipids or blood pressure)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Strychar IS, Cohn JS, Renier G, Rivard M, Aris-Jilwan N, Beauregard H, Meltzer S, Belanger A, Dumas R, Ishac A, Radwan F, Yale J-F: Effects of a diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride concentrations and other cardiovascular risk factors in type 1 diabetes. Diabetes Care, 2009; 32: 1,597-1,599.
      • Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008; 87 (1): 114-125.
  • Search Plan and Results: DM: Carbohydrate Amount 2013
     
  In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on glycemia (A1C or glucose)?

  • Conclusion

    Three studies regarding the relationship of differing amounts of carbohydrate (39% to 57% of energy), independent of weight loss, reported no significant effect on A1C in adults with type 1 and type 2 diabetes. One study in adults with type 2 diabetes reported a significantly higher fasting glucose and lower two-hour post-load glucose in subjects following a higher-carbohydrate/lower-glycemic index/lower-fat diet.

    Additional long-term studies are needed regarding the relationship of differing amounts of carbohydrate on glycemia in adults with diabetes.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on glycemia (A1C or glucose)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Delahanty LM, Nathan DM, Lachin JM, Hu FB, Cleary PA, Ziegler GK, Wylie-Rosett J, Wexler DJ, Diabetes Control and Complications Trial/Epidemiology of Diabetes. Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial. Am J Clin Nutr. 2009; 89 (2): 518-524.
      • Strychar IS, Cohn JS, Renier G, Rivard M, Aris-Jilwan N, Beauregard H, Meltzer S, Belanger A, Dumas R, Ishac A, Radwan F, Yale J-F: Effects of a diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride concentrations and other cardiovascular risk factors in type 1 diabetes. Diabetes Care, 2009; 32: 1,597-1,599.
      • Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008; 87 (1): 114-125.
  • Search Plan and Results: DM: Carbohydrate Amount 2013
     
  In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on insulin levels (exogenous or endogenous)?

  • Conclusion
    Two studies regarding the relationship of differing amounts of carbohydrate (39% to 57% of energy), independent of weight loss, reported no significant effect on exogenous insulin doses in adults with well-controlled type 1 diabetes and no significant effect on endogenous insulin levels in adults with well-controlled type 2 diabetes.

    Additional long-term studies are needed regarding the relationship of differing amounts of carbohydrate on insulin levels in adults with diabetes.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In adults with type 1 and type 2 diabetes, what is the relationship of differing amounts of carbohydrate, independent of weight loss, on insulin levels (exogenous/endogenous)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Strychar IS, Cohn JS, Renier G, Rivard M, Aris-Jilwan N, Beauregard H, Meltzer S, Belanger A, Dumas R, Ishac A, Radwan F, Yale J-F: Effects of a diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride concentrations and other cardiovascular risk factors in type 1 diabetes. Diabetes Care, 2009; 32: 1,597-1,599.
      • Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008; 87 (1): 114-125.
  • Search Plan and Results: DM: Carbohydrate Amount 2013