This article is more than 5 years old. Information may no longer be current.
Food sequence at meals can influence glucose control in type 2 diabetes
Adults with well-controlled type 2 diabetes who consumed non-glucidic foods prior to high-carbohydrate foods at mealtime saw reduced glucose variability over 2 months independent of weight loss, according to recent findings.
“This study demonstrates that by only manipulating the sequence of nutrient ingestion it is possible to improve glycemic excursions in type 2 diabetic patients in free-living conditions, and that this intervention is safe and well accepted,” Domenico Trico, of the department of clinical and experimental medicine at the University of Pisa in Rome, and colleagues wrote. “More in general, it proves the concept that it is effective and feasible to rely upon the physiologic responses acutely activated by nutrient ingestion (ie, nutrient sensing) to improve glucose homeostasis.”
In a parallel, randomized, open clinical trial, Trico and colleagues analyzed data from 17 adults aged 50 to 75 years with type 2 diabetes for 5 years or less with no comorbidities. Patients taking a medication other than metformin or sitagliptin (Januvia, Merck) were excluded. Researchers assigned nine participants to a control diet consisting of a standard 8-week dietary plan with the food composition for three typical meals and a table of possible substitutions; expected weight loss was 1 kg per month. Researchers assigned eight participants to an experimental diet that included the same information as the control diet, with the addition of indications on the macronutrient composition of foods and a recommendation to fix the sequence of macronutrient ingestion at lunch and dinner to eat high-carbohydrate foods, such as bread or pasta, after the ingestion of high-protein and high-fat foods, such as meat, fish or cheese. Blood samples were collected at baseline, 28 days and 56 days to measure blood glucose, HbA1c and lipid profile; participants were also asked to measure their blood glucose with a glucometer once weekly six times in a day (before and 2 hours after breakfast, lunch and dinner) throughout the study period.
Participants in both groups experienced similar reductions in body weight over 8 weeks (experimental diet, –1.9 kg; control diet, –2 kg); there were no between-group differences for waist circumference, serum lipids or blood pressure. However, at 8 weeks, participants in the experimental diet group saw a greater reduction in HbA1c vs. those in the control group (6.7% to 6.4% vs. 6.8% to 6.6%; P < .05 for all), associated to a 1 mmol/L decline in fasting plasma glucose, a 0.8 mmol/L decline in mean lunch and dinner glucose (95% CI, –1.4 to –0.2) and a marked reduction in postprandial glucose excursions. Participants in the control diet group saw a nonsignificant reduction in HbA1c and FPG (–0.7 mmol/L; 95% CI, –1.6 to 0.2) and no improvements in postprandial glucose excursions.
“The physiological combination of lipid and protein is likely to be more effective, by acting on multiple targets,” the researchers wrote. “Indeed, the effect on glucose tolerance of
protein alone, though persistent, was quantitatively small.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.