Article Text

Effect of meal composition and alcohol consumption on postprandial glucose concentration in subjects with type 1 diabetes: a randomized crossover trial
  1. Alia García1,
  2. Vanessa Moscardó2,
  3. Agustín Ramos-Prol3,
  4. Julián Díaz3,
  5. Miguel Boronat3,
  6. Jorge Bondia4,5,
  7. Paolo Rossetti3,5
  1. 1Department of Endocrinology, Hospital Universitario de La Ribera, Alzira, Spain
  2. 2GREENIUS Research Group, Universidad Internacional de Valencia, València, Spain
  3. 3Department of Internal Medicine, Endocrinology Unit, Hospital Francesc de Borja, Gandia, Spain
  4. 4Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain
  5. 5Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Dr Paolo Rossetti; prossetti73{at}


Introduction Meal composition is known to affect glycemic variability and glucose control in type 1 diabetes. The objective of this work was to evaluate the effect of high carbohydrate meals of different nutritional composition and alcohol on the postprandial glucose response in patients with type 1 diabetes.

Research design and methods Twelve participants were recruited to this randomized crossover trial. Following a 4-week run-in period, participants received a mixed meal on three occasions with the same carbohydrate content but different macronutrient composition: high protein-high fat with alcohol (0.7g/kg body weight, beer), high protein-high fat without alcohol, and low protein-low fat without alcohol at 2-week intervals. Plasma and interstitial glucose, insulin, glucagon, growth hormone, cortisol, alcohol, free fatty acids, lactate, and pH concentrations were measured during 6 hours. A statistical analysis was then carried out to determine significant differences between studies.

Results Significantly higher late postprandial glucose was observed in studies with higher content of fats and proteins (p=0.0088). This was associated with lower time in hypoglycemia as compared with the low protein and fat study (p=0.0179), at least partially due to greater glucagon concentration in the same period (p=0.04). Alcohol significantly increased lactate, decreased pH and growth hormone, and maintained free fatty acids suppressed during the late postprandial phase (p<0.001), without significant changes in plasma glucose.

Conclusions Our data suggest that the addition of proteins and fats to carbohydrates increases late postprandial blood glucose. Moreover, alcohol consumption together with a mixed meal has relevant metabolic effects without any increase in the risk of hypoglycemia, at least 6 hours postprandially.

Trial registration number NCT03320993.

  • diabetes mellitus
  • type 1
  • blood glucose
  • alcohol drinking

Data availability statement

Data are available upon reasonable request. The data are available on request from the corresponding author. Paolo Rossetti (

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request. The data are available on request from the corresponding author. Paolo Rossetti (

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  • Contributors PR designed the project, performed the experiments, researched the data, wrote the manuscript, contributed to the discussion, and reviewed/edited the manuscript. AG performed the experiments, researched the data, contributed to the discussion, and reviewed/edited the manuscript. VM researched the data, contributed to the discussion, and reviewed/edited the manuscript. AR-P reviewed the project, performed the experiments, and reviewed the manuscript. JD and MB designed and performed the laboratory part of the project and reviewed the manuscript. JB is the PI of the research group and acquired funding, designed the project, contributed to the discussion, and reviewed the manuscript.

  • Funding This paper presents independent research financially supported by Ministerio de Economía y Competitividad (MINECO) (DPI2016-78831-C2-1-R), Agencia Estatal de Investigación (PID2019-107722RB-C21/AEI/10.13039/501100011033), and the European Union through FEDER funds.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.