A prospective comparison of ?conventional? and high carbohydrate / high fibre / low fat diets in adults with established Type 1 (insulin-dependent) diabetes

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Abstract
Diabetic associations throughout the world are recommending high carbohydrate / high fibre / low fat diets for diabetic patients as a means of improving general health and metabolic control. We have previously shown that the efficacy of a ‘conventional’ low carbohydrate diet can be greatly increased by improving the method of dietary education. To test whether further improvement in metabolic control could be achieved by changing to a high carbohydrate / high fibre / low fat diet we have followed a group of 40 Type 1 (insulin dependent) diabetic adults for up to 19 months. They had all been prescribed a conventional low carbohydrate diet taught by one of three methods (dietician only, practical lunchtime demonstration or videotape). Those taught by dietician only were left as a control group for follow-up (group A). The others were randomized either to continue on their present diet (group B) or to change to a high carbohydrate / high fibre / low fat diet (group C). At final assessment those in groups B and C were more knowledgeable, compliant and better controlled than group A. Those in group C achieved a change from 38% carbohydrate / 43% fat / 20 g fibre daily to 45% carbohydpate / 34% fat / 32 g fibre daily. However, metabolic control in group C deteriorated while taking the high carbohydrate / high fibre / low fat diet (haemoglobin A1 went from 9.4±0.5% to 11.2±0.5%, p<0.01, over 4 months). None of the patients in group C changed their eating habits or those of their families nearly as much as was recommended. This study suggests that imaginative and practical teaching methods are the most important factor influencing dietary compliance and metabolic control in Type 1 diabetic adults and that no additional improvement is achieved in this group by changing to a high carbohydrate / high fibre / low fat diet.