A low-carbohydrate protein-rich bedtime snack to control fasting and nocturnal glucose in type 2 diabetes: A randomized trial. Issue 12 (December 2020)

• Record Type: Journal Article
• Authors: Abbie, Erica; Francois, Monique E.; Chang, Courtney R.; Barry, Julianne C.; Little, Jonathan P.
• Is Part Of: Clinical nutrition. Volume 39:Issue 12(2020)
• Page Start: 3601
• Page End: 3606
• Publication Date: 2020-12
• Subjects: Type 2 diabetes -- Diet -- Nocturnal glucose -- Insulin sensitivity -- Nutrition; AUC area under the curve -- BMI body mass index -- CGM continuous glucose monitoring -- CHO carbohydrates -- HbA1c glycated hemoglobin -- HGP hepatic glucose production -- MAGE mean amplitude of glycemic excursions -- PRO protein -- QUICKI quantitative insulin sensitivity check index -- SD standard deviation; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2020.03.008
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: In type 2 diabetes, liver insulin resistance and excess hepatic glucose production results in elevated fasting glucose. A bedtime snack has been recommended to improve fasting glucose, yet there is little evidence supporting this recommendation. Moreover, the optimal composition of a bedtime snack is unknown. Purpose: To determine whether a low-carbohydrate protein-rich bedtime snack (Egg) could reduce fasting plasma glucose levels in people with type 2 diabetes when compared to a high-carbohydrate protein-rich bedtime snack (Yogurt) or a No Bedtime Snack condition. Secondary outcomes included glucose control assessed by continuous glucose monitoring (CGM) and fasting insulin sensitivity markers. Methods: Using a randomized crossover design, participants with type 2 diabetes ( N = 15) completed three separate isocaloric conditions: i) Egg, ii) Yogurt, and iii) No Bedtime Snack, each lasting three days. CGM was collected throughout and duplicate fasting blood samples were obtained on the morning of day 4 in each condition. Results: Fasting plasma glucose ( P = 0.04, d = 0.68), insulin ( P = 0.04, d = 0.45), and nocturnal glucose ( P = 0.02, d = 0.94) were significantly lower, and quantitative insulin sensitivity check index (QUICKI; P = 0.003) was improved, in the Egg compared to the Yogurt bedtime snack. There were no significant differences between either bedtime snack and No Bedtime Snack. Conclusion: In the short-term, a low-carbohydrate bedtime snack (Egg) lowered fasting glucose and improved markers of insulin sensitivity when compared to a high-carbohydrate protein-matched bedtime snack (Yogurt). However, consuming a low- or high-carbohydrate bedtime snack did not appear to lower fasting glucose compared to consuming an isocaloric diet with no bedtime snack. Clinical trial registry: clinicaltrials.gov (NCT03207269 ).