Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet

Objective. To investigate whether glycemic and lipid control in patients wi th non-insulin-dependent diabetes (NIDDM) can be significantly improved usi ng a lowfat, vegetarian (vegan) diet in the absence of recommendations rega rding exercise or other lifestyle changes, Methods. Eleven subjects with NIDDM recruited from the Georgetown Universit y Medical Center or the local community were randomly assigned to a lowfat vegan diet (seven subjects) or a conventional lowfat diet (four subjects). Two additional subjects assigned to the control group failed to complete th e study. The diets were not designed to be isocaloric. Easting serum glucos e, body weight, medication use, and blood pressure were assessed at baselin e and biweekly thereafter for 12 weeks. Serum lipids, glycosylated hemoglob in, urinary albumin, and dietary macronutrients were assessed at baseline a nd 12 weeks. Results. Although the sample was intentionally small in accordance with the pilot study design, the 28% mean reduction in fasting serum glucose of the experimental group, from 10.7 to 7.75 mmol/L (195 to 141 mg/dl), was signi ficantly greater than the 12% decrease, from 9.86 to 8.64 mmol/L (119 to 15 7 mg/dl), for the control group (P < 0.05). The mean weight loss was 7.2 kg in the experimental group, compared to 3.8 kg for the control group (P < 0 .005). Of six experimental group subjects on oral hypoglycemic agents, medi cation use was discontinued in one and reduced in three. Insulin was reduce d in both experimental group patients on insulin. No patient in the control group reduced medication use. Differences between the diet groups in the r eductions of serum cholesterol and 24-h microalbuminuria did not reach stat istical significance; however, high-density lipoprotein concentration fell more sharply (0.20 mmol/L) in the experimental group than in the control gr oup (0.02 mmol/L) (P < 0.05). Conclusion. The use of a lowfat, vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentrat ion and body weight in the absence of recommendations for exercise. A large r study is needed for confirmation. (C) 1999 American Health Foundation and Academic Press.