In diabetes (types 1 and 2) the majority of studies (10 of 14; table 1) have shown improvements in glycosylated proteins . Where it has been assessed, improvements in clotting factors and reductions in low-density lipoprotein cholesterol and triglycerides have also been reported, particularly in individuals with elevated blood lipids . These reductions have been achieved despite no significant change in body weight. A recent meta-analysis examined the data from several randomized trials that assessed the efficacy of low glycemic index diets to control glycemia . Seven of the 10 studies included in this analysis found improvements in glycemic control with a mean reduction in hemoglobin A1c (HbA1c) of 0.43% compared to the high glycemic index diet . These data, though not in themselves definitive, are encouraging.
Drug therapies which reduce the rate of glucose absorption have also been shown to be effective in the control of diabetes and its complications. a-Glucosidase inhibitors such as acarbose, which reduce the rate of absorption of starch, sucrose, and to a lesser extent maltose, have been shown in large, multicenter trials to result in a significant reduction in HbA1c in type-2
diabetes [17, 18]. Furthermore, use of acarbose in patients with diabetes in the context of the UK Prospective Diabetes Study, improved glucose control, expressed as reduced HbAlc, to a degree similar to that achieved by current hypoglycemic therapy (e.g. metformin and sulfonylurea) . Finally, in the STOP-NIDDM trial subjects with impaired glucose tolerance who received 100 mg acarbose three times daily showed a significantly reduced rate of conversion to diabetes versus the control group .
Findings of this nature provide additional encouragement that the principle of spreading the nutrient load by dietary means, in addition to altering the amount and nature of the macronutrients, may one day play a role in modifying glycemia in the management of diabetes.
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