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

Alpana P Shukla, Jeselin Andono, Samir H Touhamy, Anthony Casper, Radu G Iliescu, Elizabeth Mauer, Yuan Shan Zhu, David S Ludwig, Louis J Aronne, Alpana P Shukla, Jeselin Andono, Samir H Touhamy, Anthony Casper, Radu G Iliescu, Elizabeth Mauer, Yuan Shan Zhu, David S Ludwig, Louis J Aronne

Abstract

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.

Keywords: Dietary Intervention; Eating Behavior(s); Postprandial Glucose Regulation; Postprandial Glycemia.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Postprandial glucose, insulin and glucagon-like peptide-1 (GLP-1) levels following carbohydrate-first (CF), carbohydrate-last (CL) and sandwich (S) meal orders. Values are mean±SEM. ¥Statistically significant differences (p

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