Does a high-carbohydrate diet have different effects in NIDDM patients treated with diet alone or hypoglycemic drugs?

OBJECTIVE - To compare the effects of a high-carbohydrate diet on blood glucose and plasma lipids in NIDDM patients with tither mild or severe glucose intolerance. RESEARCH DESIGN AND METHODS - A crossover design with a 15-day intervention diet was used. Eighteen patients were separated into two groups on the basis of hypoglycemic treatment (diet, n = 9, or diet plus glibenclamide. it = 9) and were assigned to a 15-day treatment with a high-carbohydrate/low-fiber diet containing 60% energy from carbohydrate and 20% from fat or a low-carbohydrare/low-fiber diet with 40% energy from carbohydrate and 40% from fat and then crossed over to the other diet for 15 more days. RESULTS - ?he high-carbohydrate diet produced a significant increase in postprandial blood glucose in patients on glibenclamide(13.6 +/- 1.4 vs. 11.0 +/- 1.8 mmol/l, P < 0.02), while no difference was recorded in the group on diet alone (9.7 +/- 0.9 vs. 8.9 +/- 0.6 mmol/l). Postprandial insulin levels were significantly higher alter the high-carbohydrate diet in the group on diet alone (248 +/- 32 vs. 192 +/- 28 pmol/l, P < 0.01), while no significant differences were observed in the other group (226 +/- 19 vs. 202 +/- 24 pmol/l). The high-carbohydrate diet also induced a significant increase in fasting plasma triglyceride concentrations in both groups (1.36 +/- 0.2 vs. 1.12 +/- 0.2 mmol/l, P < 0.05, and 1.4 +/- 0.3 vs. 1.1 +/- 0.1 mmol/l, P < 0.05). No differences were observed in fasting plasma cholesterol and HDL. CONCLUSIONS - The effects of the high-carbohydrate diet on blood glucose control in NIDDM patients differ according to severity of glucose intolerance.