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Carbohydrate consumption timing affects glucose, insulin excursions
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Adults with type 2 diabetes who consumed carbohydrates last during their meals had lower glucose peaks and insulin excursions and higher GLP-1 excursions compared with those who consumed carbohydrates first during their meals, study data show.
“The timing and order of carbohydrate intake during a meal has a significant impact on postprandial glucose and insulin excursions independent of the calorie and carbohydrate content of the meal,” Alpana Shukla, MD, MRCP, assistant professor of research in medicine and director of clinical research at the Comprehensive Weight Control Center, division of endocrinology, diabetes and metabolism at Weill Cornell Medicine, told Endocrine Today. “In addition to the current wisdom of eating less carbohydrates, eating carbohydrates last is a simple strategy to regulate postmeal glucose levels.”
Shukla and colleagues evaluated 16 adults (mean age, 57.7 years) with type 2 diabetes (mean diabetes duration, 3.8 years; mean HbA1c, 6.5%) assigned to consume the same meal for 3 days in random order: carbohydrate first followed by protein and vegetables; protein and vegetables first followed by carbohydrate; or all combined. Researchers sought to determine the effect of the timing of carbohydrate intake on postmeal glucose excursions.
After the carbohydrate-last meal order, postprandial glucose concentrations were 20.8% lower at 30 minutes, 30.2% lower at 60 minutes and 23.1% lower at 90 minutes compared with the carbohydrate-first meal order. Similarly, postprandial glucose concentrations were 19.8% lower at 30 minutes, 25.2% lower at 60 minutes and 15.3% lower at 90 minutes after the carbohydrate-last meal order compared with the combined meal.
The carbohydrate-last meal order had 53.8% lower incremental glucose peak than the carbohydrate-first meal order and 40.4% lower than the combined meal. Incremental glucose peaks were 22.4% lower with the combined meal compared with the carbohydrate-first meal order.
Compared with the carbohydrate-first meal order, the carbohydrate-last meal order resulted in lower insulin excursions and higher GLP-1 excursions.
“The carbohydrate-last meal pattern may be an effective behavioral strategy for glycemic management of type 2 diabetes, comparable in magnitude to many hypoglycemic drugs,” Shukla said. “The reduced insulin excursions seen with this meal pattern suggest patients may have lower insulin requirements when carbohydrate is consumed at the end of the meal. The combination of lower insulin requirements and higher GLP-1 has implications for satiety and weight management that need further study.” – by Amber Cox
For more information:
Alpana Shukla, MD, MRCP, can be reached at aps2004@med.cornell.edu.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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This study has enormous implications if it is reproducible in other settings. The effect size is large — there are twofold differences between postprandial glycemia profiles when carbohydrate component of the meal is eaten last vs. first. The effect is bigger than other measures to lower postprandial glucose, eg adding viscous fiber or acarbose to the meal. It’s easy to do, easy to instruct and likely to make a real difference to beta-cell demand and function, and therefore long-term glycemic control. I’d like to see if this study can be repeated using continuous glucose monitoring in type 2 diabetes, type 1 diabetes and prediabetes patients.
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