RT Journal Article
SR Electronic
T1 Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e000440
DO 10.1136/bmjdrc-2017-000440
VO 5
IS 1
A1 Alpana P Shukla
A1 Jeselin Andono
A1 Samir H Touhamy
A1 Anthony Casper
A1 Radu G Iliescu
A1 Elizabeth Mauer
A1 Yuan Shan Zhu
A1 David S Ludwig
A1 Louis J Aronne
YR 2017
UL http://drc.bmj.com/content/5/1/e000440.abstract
AB 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.