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Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
  1. Alpana P Shukla1,
  2. Jeselin Andono1,2,
  3. Samir H Touhamy1,2,
  4. Anthony Casper1,
  5. Radu G Iliescu1,
  6. Elizabeth Mauer3,
  7. Yuan Shan Zhu4,
  8. David S Ludwig5,
  9. Louis J Aronne1
  1. 1 Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medical College, New York, NY, USA
  2. 2 Institute of Human Nutrition, Columbia University, New York, USA
  3. 3 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, USA
  4. 4 Department of Medicine, Clinical and Translational Science Center, Weill Cornell Medical College, New York, USA
  5. 5 The New Balance Foundation Obesity Prevention Center, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Alpana P Shukla; aps2004{at}


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.

  • Dietary Intervention
  • Eating Behavior(s)
  • Postprandial Glycemia
  • Postprandial Glucose Regulation

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  • Contributors APS, DSL and LJA: study concept and design. APS: drafting of the manuscript. APS, JA, SHT, AC and YSZ: conduct of study procedures and data acquisition. RGI and EM: data analysis. APS, JA, SHT and LJA: data interpretation. All the authors contributed to the reviewing and editing of the manuscript. APS and LJA are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the data and the accuracy of the data analysis.

  • Funding Louis & Rachel Rudin Foundation Grant, Diane & Darryl Mallah.

  • Disclaimer LJA and DSL report receiving royalties for books on nutrition and obesity.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Weill Cornell Medical College Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.