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研究發現，對於2型糖尿病肥胖患者，嚴格的低碳水化合物飲食在兩週內可大幅減少能量攝入，從而導致體重下降和血糖水平正常化。此外，這種飲食還可顯著提高胰島素敏感性，降低血漿甘油三酯和膽固醇水平，但其長期效果尚不明確。

低碳水化合物飲食對2型糖尿病肥胖患者的食慾、血糖水平和胰島素抗性的影響

Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes

Guenther Boden, MD, Karin Sargrad, MS, RD, CDE, Carol Homko, PhD, RN, CDE, Maria Mozzoli, BS, and T. Peter Stein, PhD See Less
Author, Article, and Disclosure Information
https://doi.org/10.7326/0003-4819-142-6-200503150-00006

背景：

目前尚不清楚低碳水化合物、高蛋白質、高脂肪飲食是如何導致體重減輕，或者它如何影響2型糖尿病患者的血糖水平。

目的：

確定嚴格低碳水化合物飲食對2型糖尿病肥胖患者的體重、體內水分、能量攝入和消耗、血糖控制、胰島素敏感性和脂質水平的影響。

設計：

兩種飲食的住院比較。

設置：

大學醫院的一般臨床研究中心。

患者：

10名2型糖尿病的肥胖患者。

干預：

連續7天的正常飲食，接著14天的低碳水化合物飲食。

測量：

體重、水分和組成；能量攝入和消耗；飲食滿意度；血紅蛋白A1c；胰島素敏感性；24小時尿液酮排泄；以及血漿中的葡萄糖、胰島素、瘦素和胃餓素的剖面。

結果：

在低碳水化合物飲食中，平均能量攝入從每天3111千卡減少到2164千卡。平均能量赤字1027千卡/天（中位數，737千卡/天）完全解釋了14天內的體重減輕1.65公斤（中位數，14天內1.34公斤）。平均24小時血漿葡萄糖水平剖面正常化，平均血紅蛋白A1c從7.3%下降到6.8%，胰島素敏感性改善約75%。平均血漿甘油三酯和膽固醇水平下降（變化分別為-35%和-10%）。

限制：

該研究的局限性在於持續時間短，參與者人數少，以及缺乏嚴格的對照組。

結論：

在一小群有第二型糖尿病的肥胖患者中，遵循2週的低碳水化合物飲食導致能量攝入自發性減少到適合他們身高的水平；體重減輕完全歸因於減少的熱量攝入；24小時血糖剖面、胰島素敏感性和血紅蛋白A1c的顯著改善；以及血漿甘油三酯和膽固醇水平的降低。然而，這種飲食的長期效果仍然不確定。

Background:

It is not known how a low-carbohydrate, high-protein, high-fat diet causes weight loss or how it affects blood glucose levels in patients with type 2 diabetes.

Objective:

To determine effects of a strict low-carbohydrate diet on body weight, body water, energy intake and expenditure, glycemic control, insulin sensitivity, and lipid levels in obese patients with type 2 diabetes.

Design:

Inpatient comparison of 2 diets.

Setting:

General clinical research center of a university hospital.

Patients:

10 obese patients with type 2 diabetes.

Intervention:

Usual diets for 7 days followed by a low-carbohydrate diet for 14 days.

Measurements:

Body weight, water, and composition; energy intake and expenditure; diet satisfaction; hemoglobin A1c; insulin sensitivity; 24-hour urinary ketone excretion; and plasma profiles of glucose, insulin, leptin, and ghrelin.

Results:

On the low-carbohydrate diet, mean energy intake decreased from 3111 kcal/d to 2164 kcal/d. The mean energy deficit of 1027 kcal/d (median, 737 kcal/d) completely accounted for the weight loss of 1.65 kg in 14 days (median, 1.34 kg in 14 days). Mean 24-hour plasma profiles of glucose levels normalized, mean hemoglobin A1c decreased from 7.3% to 6.8%, and insulin sensitivity improved by approximately 75%. Mean plasma triglyceride and cholesterol levels decreased (change, −35% and −10%, respectively).

Limitations:

The study was limited by the short duration, small number of participants, and lack of a strict control group.

Conclusion:

In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in spontaneous reduction in energy intake to a level appropriate to their height; weight loss that was completely accounted for by reduced caloric intake; much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.