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The impact of carbohydrate intake and its sources on hemoglobin A1c levels in Japanese patients with type 2 diabetes not taking anti-diabetic medication

Authors Haimoto H, Watanabe S, Komeda M, Wakai K

Received 22 October 2017

Accepted for publication 12 January 2018

Published 9 March 2018 Volume 2018:11 Pages 53—64

DOI https://doi.org/10.2147/DMSO.S154839

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Ming-Hui Zou


Hajime Haimoto,1 Shiho Watanabe,2 Masashi Komeda,3 Kenji Wakai4

1Department of Internal Medicine, Haimoto Clinic, Kasugai, Aichi, Japan; 2Department of Clinical Nutrition, Haimoto Clinic, Kasugai, Aichi, Japan; 3Department of Cardiovascular Surgery, Jinsenkai Hospital, Morofuku, Osaka, Japan; 4Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan


Background: Although postprandial glucose levels largely depend on carbohydrate intake, the impact of carbohydrate and its sources on hemoglobin A1c (HbA1c) levels has not been demonstrated in patients with type 2 diabetes (T2DM) probably because, in previous studies, more than 50% of patients were taking anti-diabetic medication, and the researchers used energy percent of carbohydrate as an indicator of carbohydrate intake.
Patients and methods: We recruited 125 Japanese men (mean age 58±12 years) and 104 women (mean age 62±10 years) with T2DM who were not taking anti-diabetic medication and dietary therapy. We used 3-day dietary records to assess total carbohydrate intake and its sources, computed Spearman’s correlation coefficients, and conducted multiple regression analyses for associations of carbohydrate sources with HbA1c by sex.
Results: Mean HbA1c and total carbohydrate intake were 8.2%±1.9% and 272.0±84.6 g/day in men and 7.6%±1.3% and 226.7±61.5 g/day in women, respectively. We observed positive correlation of total carbohydrate intake (g/day) with HbA1c in men (rs=0.384) and women (rs=0.251), but no correlation for % carbohydrate in either sex. Regarding carbohydrate sources, we found positive correlations of carbohydrate from noodles (rs=0.231) and drinks (rs=0.325), but not from rice, with HbA1c in men. In women, carbohydrate from rice had a positive correlation (rs=0.317), but there were no correlations for carbohydrate from noodles and drinks. The association of total carbohydrate intake (g/day) and carbohydrate from soft drinks with HbA1c in men remained significant even after adjustment for total energy by multiple regression analyses.
Conclusion: Our findings warrant interventional studies for moderate low-carbohydrate diets that focus on carbohydrate sources and sex differences in order to efficiently decrease HbA1c in patients with T2DM.

Keywords: carbohydrate intake, type 2 diabetes, carbohydrate sources, rice, soft drinks, low-carbohydrate diet

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