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Randomized Controlled Trial
. 2020 Feb 13;12(2):475.
doi: 10.3390/nu12020475.

Effect of High Versus Low Carbohydrate Intake in the Morning on Glycemic Variability and Glycemic Control Measured by Continuous Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus-A Randomized Crossover Study

Louise Rasmussen  1 , Maria Lund Christensen  1 , Charlotte Wolff Poulsen  2 , Charlotte Rud  3 , Alexander Sidelmann Christensen  4   5 , Jens Rikardt Andersen  1 , Ulla Kampmann  6 , Per Glud Ovesen  2
Affiliations
Randomized Controlled Trial

Effect of High Versus Low Carbohydrate Intake in the Morning on Glycemic Variability and Glycemic Control Measured by Continuous Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus-A Randomized Crossover Study

Louise Rasmussen et al. Nutrients. .

Abstract

Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (-0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (-0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.

Keywords: breakfast diet; carbohydrate distribution; gestational diabetes mellitus; glycemic variability; mean amplitude of glucose.

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Conflict of interest statement

The authors declare no conflict of interest. ASC is a minority shareholder in Pharmacosmos A/S.

Figures

Figure 1
Figure 1
Flow chart of the study. HCM, high carbohydrate and energy content in the morning; LCM, low carbohydrate and energy content in the morning.
Figure 2
Figure 2
Treatment effect on mean amplitude of glucose excursions (MAGE) for each participant following a diet with two days of high carbohydrate load (HCM) and two days of low carbohydrate load (LCM) in the morning. Mean values of the treatment effect of each period are marked with black lines. HCM, high carbohydrate and energy content in the morning; LCM, low carbohydrate and energy content in the morning; MAGE, mean amplitude of glucose excursions.
Figure 3
Figure 3
Treatment effect on mean glucose (MG) for each participant following a diet with high carbohydrate load (HCM) and a diet with low carbohydrate load (LCM) in the morning. Mean values of the treatment effect of each period are marked with black lines. HCM, high carbohydrate and energy content in the morning; LCM, low carbohydrate and energy content in the morning; MG, mean glucose.
See this image and copyright information in PMC

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