Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes. Issue 1 (14th September 2017)

• Record Type: Journal Article
• Authors: Shukla, Alpana P; Andono, Jeselin; Touhamy, Samir H; Casper, Anthony; Iliescu, Radu G; Mauer, Elizabeth; Shan Zhu, Yuan; Ludwig, David S; Aronne, Louis J
• Is Part Of: BMJ open diabetes research and care. Volume 5:Issue 1(2017)
• Publication Date: 2017-09-14
• Subjects: Dietary Intervention -- Eating Behavior(s) -- Postprandial Glycemia -- Postprandial Glucose Regulation; Diabetes -- Periodicals; 616.462005
• DOI: 10.1136/bmjdrc-2017-000440
• Languages: English
• ISSNs: 2052-4897

Abstract

Abstract : Background: There are limited data regarding the timing of carbohydrate ingestion during a meal and postprandial glucose regulation. Methods: Sixteen subjects with type 2 diabetes mellitus (T2DM) consumed the same meal on 3 days in random order: carbohydrate first, followed 10 min later by protein and vegetables; protein and vegetables first, followed 10 min later by carbohydrate; or all components together. Blood was sampled for glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucagon measurements at baseline (just before meal ingestion) and subsequently at 30 min intervals up to 180 min. Results: The incremental areas under the curve for glucose (iAUC0–180 ) and incremental glucose peaks were 53% and 54% lower, respectively, when carbohydrate was consumed last compared with carbohydrate consumed first (3124.7±501.2 vs 6703.5±904.6 mg/dL×180min, p<0.001; 34.7±4.1 vs 75.0±6.5 mg/dL, p<0.001) and 44% and 40% lower, respectively, compared with the all components together condition (3124.7±501.2 vs 5587.1±828.7 mg/dL×180min, p=0.003; 34.7±4.1 vs 58.2±5.9 mg/dL, p<0.001). Postprandial insulin excursions were lower (iAUC0–180 : 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC0–180 : 3487.56±327.7 vs 2519.11±494.8 pg/mL×min, p=0.019) following the carbohydrate-last meal order compared with carbohydrate first. Conclusion: The carbohydrate-last meal pattern may be an effective behavioral strategy to improve postprandial glycemia.