07-16-2008, 04:48 PM
07-16-2008, 06:01 PM
There have been so many of these studies, but nice to see it in the NEJM. There is a 10 year diffusion of innovation from the thought leaders to regular practice, so even if the thought leaders get converted soon, it will still be a while.
Note that the conclusion is that it may be OK to offer the low-carb and med diets as an alternative to low-fat, despite the fact that low fat scored by far the worst.
The most surprising finding of the study is that insulin and glucose levels in diabetics declined the most in the med diet, not the low carb. Not reported in the summary but in the full text, the low carb group had the greatest decline in Hba1c, which tends to measure exposure to glucose over time.
Something was weird with the sample for the low-carb group with diabetes, because fasting glucose declined the first 12 months, then atypically shot back up at the 24 month mark. Given the low sample size, could have been a few people who fell off the wagon.
Fasting insulin declined dramatically for the low-carb group in non-diabetics, where the n was greater.
(Note that the low fat diabetic group actually saw an increase in fasting glucose over time despite the caloric restriction).
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