A pilot study on the effect of D-allulose on postprandial glucose levels in patients with type 2 diabetes mellitus during Ramadan fasting

Abstract

Background: During Ramadan fasting, postprandial hyperglycemia is commonly observed after iftar (break of fast at sunset) meal. D-allulose is a rare sugar and is reported to have several health benefits, including the suppression of increase in postprandial glucose levels. This study investigates whether D-allulose (a C-3 epimer of D-fructose) improves the postprandial glucose in patients with type 2 diabetes mellitus (T2DM) during Ramadan.

Methods: This was a pilot, prospective single-arm study design that was conducted for 10 consecutive days; 5 days of control and 5 days of consumption. The primary outcome was postprandial peak glucose levels. During the consumption period, 8.5 g of D-allulose was consumed by the participants before iftar meal. Postprandial glucose was measured using a continuous glucose monitoring system.

Results: A total of 12 participants completed the study. Significant lower (p < 0.01) postprandial glucose values and the glucose incremental area under the curve (iAUC) were observed from 0 to 180 min during the consumption period compared to the control period. The consumption period demonstrated significantly higher percentages of time in which glucose values were found in the target range (p = 0.0032), and when the glucose levels above the target range were reduced (p = 0.0015).

Conclusions: The supplementation with D-allulose has the potential to improve postprandial hyperglycemia in patients with T2DM after iftar during Ramadan. Further studies are needed to confirm these findings. Trial registration ClinicalTrials.gov NCT05071950. Retrospectively registered, 8 October 2021.

Keywords: CGM; D-allulose; Ramadan; Type 2 diabetes mellitus; postprandial glucose.

Fig. 1

Graphic presentation of the study design. All participants underwent 10 days study period consecutively; began with 5 days control period and the following 5 days of consumption period

Fig. 2

The flow chart of participant enrollment

Fig. 3

The comparison of postprandial glucose at control and consumption (D-allulose) periods. Figure 3a shows postprandial glucose at 0 (pre) to 180 min after iftar and Fig. 3b shows the average glucose incremental area under the curve (iAUC) (3b) within 180 min after iftar. Data reported as mean ± SD of glucose values of 5 days of the control period and 5 days of the consumption period. Postprandial glucose levels were significantly different between both periods (*p < 0.05; **p < 0.01)

Fig. 4

The effect of D-allulose during the consumption period compared to control period on the percentage of time postprandial glucose in-target range (%TIR), percentage of time glucose above-target range (%TAR) and percentage of time glucose below-target range (%TBR). Percentages of TIR, TAR and TBR were analyzed by obtaining the average of frequency glucose in TIR, TAR and TBR for 5 days (control and consumption periods) at 15 to 180 min after iftar. The average then divided by 12 times point and multiple with 100. Data reported as mean ± SD. There were significant differences of postprandial glucose between both periods (**p < 0.01)

Fig. 5

The average 24-h glucose changes, average % of TIR, TBR and TAR for 5 days (control and consumption periods). Data reported as mean and percentage (%)