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. 2017 Sep 14;5(1):e000440.
doi: 10.1136/bmjdrc-2017-000440. eCollection 2017.

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

Alpana P Shukla  1 , Jeselin Andono  1   2 , Samir H Touhamy  1   2 , Anthony Casper  1 , Radu G Iliescu  1 , Elizabeth Mauer  3 , Yuan Shan Zhu  4 , David S Ludwig  5 , Louis J Aronne  1
Affiliations

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

Alpana P Shukla et al. BMJ Open Diabetes Res Care. .

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.

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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<0.05) between CF and CL. ΘStatistically significant differences (p<0.05) between CF and S. ◊Statistically significant differences (p<0.05) between CL and S.
See this image and copyright information in PMC

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