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Archived Comments for: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

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  1. tight diabetic control

    Laura LaValle, LaValle Metabolic Institute

    3 February 2009

    I have been closely following the work of Dr. Westman and other researchers looking at low carbohydrate diets for diabetes and weight management. I have been using low carbohydrate diets with great results in clinical practice. I noted some comments by other researchers in an article about this study written by Shelly Wood which appeared in Medscape, notably that we should not be striving for the lowest HbA1 c levels. <br><br>Since the ACCORD trial, medicine has cautioned against the lowering of HbA1c's. A distinction between the ACCORD trial and some other studies looking at tighter control in diabetics, is that the primary intervention used to achieve the control was increased medication and/or insulin. <br><br>While the researchers involved in the ACCORD trial stated that they evaluated whether the increased risk of death that was found in the tight control groups could have been due to medication, the evaluation was whether any single medication seemed to increase risks. The result of the ACCORD trial to me showed that the increased medication dosages in any combination increased risk of death. <br><br>I believe that it is a big mistake to compare dietary control of diabetes as indicated by a lowered HbA1c to "any other pharmaceutical intervention" as was stated by Dr. McGuire in the Medscape article. A dietary intervention is distinctly different. <br><br>I hope Dr. Westman that your desired future trial which was noted in the Medscape article gets funded and that you can evaluate the micro and macrovascular health as Dr. McGuire suggests.<br><br>I have personally seen cardiac scores improve after implementation of low carb diets. By the way, in our private practice, we get good results with a 20 to 30% carb diet, with most carbs coming from non-starchy vegetables. This level seems to greatly improve adherence to the diet, and may help the drop out level.<br><br>

    Competing interests

    None declared