Effect of a Low–Glycemic Index or a High–Cereal Fiber Diet on Type 2 Diabetes: A Randomized Trial
Abstract
CONTEXT: Clinical trials using antihyperglycemic medications to improve glycemic control have not demonstrated the anticipated cardiovascular benefits. Low-glycemic index diets may improve both glycemic control and cardiovascular risk factors for patients with type 2 diabetes but debate over their effectiveness continues due to trial limitations. OBJECTIVE: To test the effects of low-glycemic index diets on glycemic control and cardiovascular risk factors in patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: A randomized, parallel study design at a Canadian university hospital research center of 210 participants with type 2 diabetes treated with antihyperglycemic medications who were recruited by newspaper advertisement and randomly assigned to receive 1 of 2 diet treatments each for 6 months between September 16, 2004, and May 22, 2007. INTERVENTION: High-cereal fiber or low-glycemic index dietary advice. MAIN OUTCOME MEASURES: Absolute change in glycated hemoglobin A(1c) (HbA(1c)), with fasting blood glucose and cardiovascular disease risk factors as secondary measures. RESULTS: In the intention-to-treat analysis, HbA(1c) decreased by -0.18% absolute HbA(1c) units (95% confidence interval [CI], -0.29% to -0.07%) in the high-cereal fiber diet compared with -0.50% absolute HbA(1c) units (95% CI, -0.61% to -0.39%) in the low-glycemic index diet (P < .001). There was also an increase of high-density lipoprotein cholesterol in the low-glycemic index diet by 1.7 mg/dL (95% CI, 0.8-2.6 mg/dL) compared with a decrease of high-density lipoprotein cholesterol by -0.2 mg/dL (95% CI, -0.9 to 0.5 mg/dL) in the high-cereal fiber diet (P = .005). The reduction in dietary glycemic index related positively to the reduction in HbA(1c) concentration (r = 0.35, P < .001) and negatively to the increase in high-density lipoprotein cholesterol (r = -0.19, P = .009). CONCLUSION: In patients with type 2 diabetes, 6-month treatment with a low-glycemic index diet resulted in moderately lower HbA(1c) levels compared with a high-cereal fiber diet. Trial Registration clinicaltrials.gov identifier: NCT00438698.
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Reducing GI or GL in the context of diets low in saturated fat can improve CHD risk factors including BMI, blood pressure, and serum cholesterol.
“Over the last 3 decades, clinical trials have demonstrated that reducing the GI or glycemic load (GL), the product of GI and the available carbohydrate content of a food,13 in the context of diets low in saturated fat, can improve CHD risk factors including body mass index (BMI), blood pressure, and serum cholesterol.14–24”
From Associations of Glycemic Index and Load With Coronary Heart Disease Events: A Systematic Review and Meta‐Analysis of Prospective Cohorts (2012) · cites this paper as [15]
Low-glycemic index diets improve glycemic control and serum lipids in RCTs of participants with T2DM with major implications for CHD risk reduction in this vulnerable segment of the population.
“Furthermore, low-glycemic index diets improve glycemic control and serum lipids in RCTs of participants with T2DM with major implications for CHD risk reduction in this vulnerable segment of the population whose numbers are increasing rapidly globally (116–119).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [118]
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- Authors
- Jenkins, D. J. A., Kendall, C. W. C., McKeown-Eyssen, G., Josse, R. G., Silverberg, J., Booth, G. L., Vidgen, E., Josse, A. R., Nguyen, T. H., Corrigan, S., Banach, M. S., Ares, S., Mitchell, S., Emam, A., Augustin, L. S. A., Parker, T. L., & Leiter, L. A.
- Affiliations
- St. Michael's Hospital (CA)
- Corresponding author
- Jenkins, David J. A.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2008-12-17
- Volume
- 300
- Issue
- 23
- Pages
- 2742
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2035569239
- Cited by
- 718
- References
- 44
- Citations by year
- 2026: 6 · 2025: 19 · 2024: 15 · 2023: 12 · 2022: 68 · 2021: 56 · 2020: 26 · 2019: 12 · 2018: 19 · 2017: 18 · 2016: 154 · 2015: 60 · 2014: 32 · 2013: 85 · 2012: 38
- FWCI
- 30.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, low glycemic index diet, glycemic control, HbA1c, cardiovascular risk factors, HDL cholesterol, dietary intervention, antihyperglycemic medications, fasting blood glucose, cardiovascular disease prevention, lifestyle modification, glycemic index, dietary fiber, intention-to-treat analysis
- MeSH terms
- Aged, Hypolipidemic Agents, Blood Glucose, Cardiovascular Diseases, Edible Grain, Combined Modality Therapy, Diabetes Mellitus, Type 2, Dietary Carbohydrates, Dietary Fiber, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Risk Factors, Glycemic Index
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