A greater glycemic load reduction was associated with a lower diabetes risk in pre-diabetic patients who consume a high glycemic load diet

Few prospective studies evaluating the association between dietary glycemic load (GL) and diabetes have accounted for changes in GL. However, the diet of patients could be modified in response to an awareness of pre-diabetes. The aim of this study was to examine the longitudinal associations between changes in GL and the incidence of diabetes among pre-diabetic patients. We hypothesized that subjects with low and high baseline GL would show different correlations with diabetes. A total of 493 pre-diabetic patients (142 men and 351 women) between 40 and 79 years of age were included in this study. Dietary records and oral glucose tolerance tests were conducted every year. The participants were divided into low and high-GL groups based on baseline GL. During a median 4 years of follow-up, 108 incident cases of diabetes were identified. Among participants with a high baseline GL, the incidence of diabetes increased with decreasing GL reduction, and the multivariate-adjusted HR (95% CI) was 2.34 (1.27-4.29) when comparing the lowest to the highest tertiles; however, among those with a low baseline GL, no significant association was observed. Regardless of baseline GL status, the incidence of diabetes was higher in individuals with a high follow-up GL than in those with a low follow-up GL, and the multivariate-adjusted HR (95% CI) was 1.64 (1.09-2.45). In conclusion, a greater GL reduction was associated with a lower diabetes risk in pre-diabetic patients with a high dietary GL. In patients with pre-diabetes and a low dietary GL, further reductions in GL did not show any additional effects. (C) 2018 Elsevier Inc. All rights reserved.