RESPONSE TO HIGH-CARBOHYDRATE AND HIGH MONOUNSATURATED FAT DIETS IN HYPERTRIGLYCERIDEMIC NON-INSULIN-DEPENDENT DIABETIC-PATIENTS WITH POOR GLYCEMIC CONTROL

The aim of this study was to assess the effects of two controlled diet s, one rich in oleic acid, the other rich in complex carbohydrates, on fasting serum lipids and glycemic control in NIDDM patients with hype rtriglyceridemia and poor blood glucose control, A randomized crossove r study was designed, Patients were included if they met the following criteria; poor glycemic control (mean fasting blood glucose > 180 mg/ dl, glycosilated hemoglobin > 9.5% (normal ranges 5-8%) and elevated f asting triglyceride levels (mean fasting triglycerides > 150 mg/dl), i n absence of a concurrent acute illness, a thyroid, renal or hepatic d isease, They were randomly assigned to alternatively receive both stud y diets, one high in monounsaturated fatty acids (HMUFA) and a diet hi gh in complex carbohydrates (HCHO), during two 6-week periods, with a washout period of 6 weeks in between, during which the patients follow ed their habitual diets, Blood samples were obtained before and after each dietary period, Most patients remained in poor metabolic control, even though they were following the diets, and that minor treatment a djustments were done after the first dietary period, This was probably related to secondary failure of oral agents, increased insulin requir ements, and insulin resistance related to chronic hyperglycemia. The H CHO diet was associated with major increments in glycemia and HbA(1), Triglycerides increased similarly after both dietary periods, The main determinant for the high triglyceride values was glycemic control, an d in some patients probably an associated primary dyslipidemia, Conclu sions: In NIDDM patients with poor glycemic control the optimization o f dietary treatment alone does not necessarily ameliorate the altered glucose and lipid metabolism, In this selected group of patients, high carbohydrate diets appear to be less appropriate when compared to HMU FA diets because these led to a further increase in blood glucose conc entrations at least over a short-term period. A hypotriglyceridemic ef fect was not observed with the HMUFA diets.