A RANDOMIZED CLINICAL-TRIAL OF A FIBER-ENRICHED DIABETIC DIET VS THE STANDARD AMERICAN-DIABETES-ASSOCIATION RECOMMENDED DIET IN THE MANAGEMENT OF DIABETES-MELLITUS IN PREGNANCY

Objective: In light of the reported effectiveness of high-fiber diets in achieving improved glycemic control and reducing insulin requiremen ts in the nonpregnant diabetic state, along with the need to maintain euglycemia in pregnancy, we initiated a randomized trial to test the e ffects of a high-fiber diet on metabolic control and pregnancy outcome s. Methods: Subjects were assigned to either the American Diabetes Ass ociation (ADA) diet or a fiber-enriched diet (80 g/day; 40 g/day of fi ber in fiber-rich foods and an additional 40 g/day in a high-fiber dri nk). Of the 50 subjects randomized (24 to fiber-enriched diet and 26 t o ADA diet), 28 were insulin-dependent diabetics (13 to fiber-enriched diet and 15 to ADA diet) and 22 were gestational diabetics (11 to fib er-enriched diet and 11 to ADA diet). Results: Dietary compliance was good in 60% and acceptable in 40%; in none was compliance considered u nacceptable. The number of hypoglycemic episodes was lower in the fibe r-enriched diet group than in the ADA diet subjects; however, no signi ficant difference was observed between the two treatment groups regard ing the overall glycemic control (mean blood glucose and mean glycosyl ated hemoglobin levels), the mean number of hypoglycemic reactions, th e mean birth weight, and the mean gestational age at delivery, Conclus ion: A fiber-enriched diet did not improve overall glycemic control in our study group. However, fewer hypoglycemic episodes were associated with this diet therapy. Further studies are needed to explore the rol e of fiber therapy during pregnancy in reducing aberrant glycemic excu rsions.