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Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes

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 a...

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Autores principales: Shukla, Alpana P, Andono, Jeselin, Touhamy, Samir H, Casper, Anthony, Iliescu, Radu G, Mauer, Elizabeth, Shan Zhu, Yuan, Ludwig, David S, Aronne, Louis J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604719/
https://www.ncbi.nlm.nih.gov/pubmed/28989726
http://dx.doi.org/10.1136/bmjdrc-2017-000440
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author Shukla, Alpana P
Andono, Jeselin
Touhamy, Samir H
Casper, Anthony
Iliescu, Radu G
Mauer, Elizabeth
Shan Zhu, Yuan
Ludwig, David S
Aronne, Louis J
author_facet Shukla, Alpana P
Andono, Jeselin
Touhamy, Samir H
Casper, Anthony
Iliescu, Radu G
Mauer, Elizabeth
Shan Zhu, Yuan
Ludwig, David S
Aronne, Louis J
author_sort Shukla, Alpana P
collection PubMed
description 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 (iAUC(0–180)) 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 (iAUC(0–180): 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC(0–180): 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.
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spelling pubmed-56047192017-10-06 Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes Shukla, Alpana P Andono, Jeselin Touhamy, Samir H Casper, Anthony Iliescu, Radu G Mauer, Elizabeth Shan Zhu, Yuan Ludwig, David S Aronne, Louis J BMJ Open Diabetes Res Care Clinical Care/Education/Nutrition 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 (iAUC(0–180)) 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 (iAUC(0–180): 7354.1±897.3 vs 9769.7±1002.1 µU/mL×min, p=0.003) and GLP-1 excursions higher (iAUC(0–180): 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. BMJ Publishing Group 2017-09-14 /pmc/articles/PMC5604719/ /pubmed/28989726 http://dx.doi.org/10.1136/bmjdrc-2017-000440 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Clinical Care/Education/Nutrition
Shukla, Alpana P
Andono, Jeselin
Touhamy, Samir H
Casper, Anthony
Iliescu, Radu G
Mauer, Elizabeth
Shan Zhu, Yuan
Ludwig, David S
Aronne, Louis J
Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title_full Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title_fullStr Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title_full_unstemmed Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title_short Carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
title_sort carbohydrate-last meal pattern lowers postprandial glucose and insulin excursions in type 2 diabetes
topic Clinical Care/Education/Nutrition
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604719/
https://www.ncbi.nlm.nih.gov/pubmed/28989726
http://dx.doi.org/10.1136/bmjdrc-2017-000440
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