The impact of carbohydrate intake and its sources on hemoglobin A1c levels in Japanese patients with type 2 diabetes not taking anti-diabetic medication

Abstract

Background: Although postprandial glucose levels largely depend on carbohydrate intake, the impact of carbohydrate and its sources on hemoglobin A1c (HbA1c) levels has not been demonstrated in patients with type 2 diabetes (T2DM) probably because, in previous studies, more than 50% of patients were taking anti-diabetic medication, and the researchers used energy percent of carbohydrate as an indicator of carbohydrate intake.

Patients and methods: We recruited 125 Japanese men (mean age 58±12 years) and 104 women (mean age 62±10 years) with T2DM who were not taking anti-diabetic medication and dietary therapy. We used 3-day dietary records to assess total carbohydrate intake and its sources, computed Spearman's correlation coefficients, and conducted multiple regression analyses for associations of carbohydrate sources with HbA1c by sex.

Results: Mean HbA1c and total carbohydrate intake were 8.2%±1.9% and 272.0±84.6 g/day in men and 7.6%±1.3% and 226.7±61.5 g/day in women, respectively. We observed positive correlation of total carbohydrate intake (g/day) with HbA1c in men (r_s=0.384) and women (r_s=0.251), but no correlation for % carbohydrate in either sex. Regarding carbohydrate sources, we found positive correlations of carbohydrate from noodles (r_s=0.231) and drinks (r_s=0.325), but not from rice, with HbA1c in men. In women, carbohydrate from rice had a positive correlation (r_s=0.317), but there were no correlations for carbohydrate from noodles and drinks. The association of total carbohydrate intake (g/day) and carbohydrate from soft drinks with HbA1c in men remained significant even after adjustment for total energy by multiple regression analyses.

Conclusion: Our findings warrant interventional studies for moderate low-carbohydrate diets that focus on carbohydrate sources and sex differences in order to efficiently decrease HbA1c in patients with T2DM.

Keywords: carbohydrate intake; carbohydrate sources; low-carbohydrate diet; rice; soft drinks; type 2 diabetes.

Figure 1

Correlations of carbohydrate intake and its sources with HbA1c in men. Notes: Closed circles indicate total carbohydrate intake (A) and open circles % carbohydrate (B). Closed triangles indicate carbohydrate from staple foods (C), open diamonds that from noodles (D), closed ovals indicate carbohydrate from rice (E), and closed diamonds that from soft drinks (F). Total carbohydrate intake (A) positively and moderately correlated with HbA1c levels, while there was no correlation for % carbohydrate (B). We also found a positive and moderate association of carbohydrate from soft drinks with HbA1c (F) and positive but weak association of carbohydrate from staple foods (C) and noodles (D), while there was no association of carbohydrate from rice (E). Abbreviation: HbA1c, hemoglobin A1c.

Figure 2

Correlations of carbohydrate intake and its sources with HbA1c in women. Notes: Closed circles indicate total carbohydrate intake (A) and open circles % carbohydrate (B). Closed triangles indicate carbohydrate from staple foods (C), closed ovals that from rice (D), closed diamonds indicate carbohydrate from soft drinks (E) and open ovals that from fruits (F). Total carbohydrate intake (A) was positively but weakly correlated with HbA1c levels, while there was no correlation for % carbohydrate (B). We also found a positive but weak correlation of carbohydrate from staple foods (C) and a positive and moderate correlation of that from rice (D) with HbA1c, but no correlation for carbohydrates from soft drinks (E) and fruits (F). The data for 2 outliers were excluded from the analysis for carbohydrate from fruits (arrows). Abbreviation: HbA1c, hemoglobin A1c.