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Barouti AA, Björklund A, Catrina SB, Brismar K, Rajamand Ekberg N. Effect of Isocaloric Meals on Postprandial Glycemic and Metabolic Markers in Type 1 Diabetes-A Randomized Crossover Trial. Nutrients 2023; 15:3092. [PMID: 37513510 PMCID: PMC10386239 DOI: 10.3390/nu15143092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to assess the effect of four isocaloric meals with different macronutrient compositions on postprandial blood glucose, lipids, and glucagon in adults with type 1 diabetes (T1D). Seventeen subjects tested four isocaloric meals in a randomized crossover design. The meal compositions were as follows: high-carbohydrate (HC); high-carbohydrate with extra fiber (HC-fiber); low-carbohydrate high-protein (HP); and low-carbohydrate high-fat (HF). Blood glucose and lipid measurements were collected up to 4 h and glucagon up to 3 h postprandially. Mean postprandial glucose excursions were lower after the HP compared to the HC (p = 0.036) and HC-fiber meals (p = 0.002). There were no differences in mean glucose excursions after the HF meal compared to the HC and HP meals. The HF meal resulted in higher triglyceride excursions compared to the HP meal (p < 0.001) but not compared to the HC or HC-fiber meals. Glucagon excursions were higher at 180 min after the HP meal compared to the HC and HF meals. In conclusion, the low-carbohydrate HP meal showed the most favorable glycemic and metabolic effects during a 4 h postprandial period in subjects with T1D.
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Affiliation(s)
- Afroditi Alexandra Barouti
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, 11365 Stockholm, Sweden
| | - Anneli Björklund
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, 11365 Stockholm, Sweden
| | - Sergiu Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, 11365 Stockholm, Sweden
| | - Kerstin Brismar
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17176 Stockholm, Sweden
| | - Neda Rajamand Ekberg
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17176 Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, 11365 Stockholm, Sweden
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Abdou M, Hafez MH, Anwar GM, Fahmy WA, Abd Alfattah NM, Salem RI, Arafa N. Effect of high protein and fat diet on postprandial blood glucose levels in children and adolescents with type 1 diabetes in Cairo, Egypt. Diabetes Metab Syndr 2021; 15:7-12. [PMID: 33276255 DOI: 10.1016/j.dsx.2020.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS To determine the effect of high protein and high fat meals on post prandial glycemia in patients with type 1 diabetes. METHODS This study included 51 children and adolescents with type 1 diabetes who were following up at Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Abo Elrish Children's hospital, Cairo University. Post prandial blood glucose levels were recorded and compared following three breakfast meals with varying protein and fat content (standard carbohydrate meal, high fat meal, and high protein meal) over a period of 5 hours on 3 consecutive days. RESULTS High protein meal resulted in hyperglycemia with the peak level at 3.5 hours and continued for 5 hours post prandial while high fat meal caused early hyperglycemia reached the peak at 2 hours then declined towards 5 hours. Comparison of the three different breakfast meals revealed statistically significant difference regarding the postprandial glycemia at 30, 60, 90,120, 180, 210, 240, 270, 300 min. CONCLUSION Meals high in protein caused sustained increase in postprandial glucose levels over a period of 5 h. However, high fat meals caused early postprandial hyperglycemia. Protein and fat content of meals affect the timing and values of the peak blood glucose as well as the duration of postprandial hyperglycemia. Therefore, fat/protein unit should be taken in consideration while calculating the bolus insulin dose and anticipating the postprandial glucose response.
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Affiliation(s)
- Marise Abdou
- Department of Pediatrics, Member of the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Mona Hassan Hafez
- Department of Pediatrics, Faculty of Medicine, Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Children Hospital, Cairo University, Cairo, Egypt.
| | - Ghada Mohammad Anwar
- Department of Pediatrics, Faculty of Medicine, Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU), Children Hospital, Cairo University, Cairo, Egypt.
| | - Wafaa Ahmed Fahmy
- Head of Growth and Nutrient Requirements Department, National Nutrition Institute, Cairo, Egypt.
| | | | - Rania Ibrahim Salem
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Noha Arafa
- Department of Pediatrics, Member of the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Faculty of Medicine, Cairo University, Cairo, Egypt.
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González-Rodríguez M, Pazos-Couselo M, García-López JM, Rodríguez-Segade S, Rodríguez-García J, Túñez-Bastida C, Gude F. Postprandial glycemic response in a non-diabetic adult population: the effect of nutrients is different between men and women. Nutr Metab (Lond) 2019; 16:46. [PMID: 31346341 PMCID: PMC6637571 DOI: 10.1186/s12986-019-0368-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is a growing interest in the pathopysiological consequences of postprandial hyperglycemia. It is well known that in diabetic patients 2 h plasma glucose is a better risk predictor for coronary heart disease than fasting plasma glucose. Data on the glycemic response in healthy people are scarce. Objective To evaluate the effect of macronutrients (carbohydrates, fats, and proteins) and fiber on postprandial glycemic response in an observational study of a non-diabetic adult population. Design Cross-sectional study. 150 non-diabetic adults performed continuous glucose monitoring for 6 days. During this period they recorded food and beverage intake. The participants were instructed not to make changes in their usual diet and physical exercise. Variables analyzed included clinical parameters (age, sex, body weight, height, body mass index, blood pressure, and waist measurement), meal composition (calories, carbohydrates, fats, proteins, and fiber) and glycemic postprandial responses separated by sexes. The study period was defined from the start of dinner to 6 h later. Results A total of 148 (51% women) subjects completed all study procedures. Dinner intake was higher in males than in females (824 vs 531 kcal). Macronutrient distribution was similar in both sexes. No significant differences were found in fiber intake between men and women (5.5 g vs 4.5 g). In both sexes, the higher intake of carbohydrates corresponded to a significantly higher glycemic response (p = 0.0001 in women, p = 0.022 in men). Moreover, in women, as fat intake was higher, a flattening of the postprandial glycemic curve was observed (p = 0.003). With respect to fiber, a significantly lower glycemic response was observed in the group of women whose fiber intake at dinner was higher (p = 0.034). Conclusions Continuous glucose monitoring provides important information about glucose levels after meals. In this study, the postprandial glycemic response in women was different from that of men, and carbohydrates were the main determinant of elevated postprandial glucose levels.
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Affiliation(s)
- María González-Rodríguez
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain.,2Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José M García-López
- 1Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario de Santiago de Compostela, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain.,2Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Santiago Rodríguez-Segade
- 3Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Javier Rodríguez-García
- 3Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Francisco Gude
- 5Clinical Epidemiology Unit, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Postprandial glucose response after the consumption of three mixed meals based on the carbohydrate counting method in adults with type 1 diabetes. A randomized crossover trial. Clin Nutr ESPEN 2019; 31:48-55. [PMID: 31060834 DOI: 10.1016/j.clnesp.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/16/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND & AIMS People on intensive insulin therapy usually calculate their premeal insulin dose based on the total amount of consumed carbohydrates. However, arguments have been expressed supporting that also the protein and fat content of the meals should be considered when estimating premeal insulin dose. We examined the effectiveness of the carbohydrate counting method after consumption of mixed meals, and we further explored the effects of added extra virgin olive oil in these mixed meals, in adults with type 1 diabetes. METHODS Twenty adults (35.0 ± 8.9 years, BMI 27 ± 5 kg/m2) with diabetes duration 17 ± 11 years, on intensive insulin therapy with multiple injections, consumed 3 mixed meals (pasticcio, chicken with vegetables and baked giant beans), with and without the addition of 11 ml extra virgin olive oil (total of 6 meals), in random order, with the insulin dose determined by using the carbohydrate counting method. Capillary blood glucose was measured at premeal (baseline) and 30, 60, 90, 120, 150 and 180 min after meal consumption. At every visit, participants were assessed for anthropometric parameters and subjective stress. RESULTS Participants had mean HbA1c 7.5 ± 1.2%, mean carbohydrate to insulin ratio 9:1 IU and stable body weight, waist circumference and subjective stress throughout the study. The mean glucose concentration, for all 6 meals, 120 min postprandially was within target (<180 mg/dl) in nearly 80% of the sample. Addition of olive oil produced sustained increased postprandial glucose concentrations only to pasticcio meal, although within target, and no significant differences were noticed for the grilled chicken with vegetables or the baked giant beans (legume) meals. CONCLUSIONS The carbohydrate-counting method was effective for achieving postprandial glucose levels within target threshold up to 3 h postprandially. Moreover, adding small amounts of dietary fat (extra virgin olive oil) to low fat meals does not significantly alter the postprandial response within the first 3 h, whereas caused a sustained increase in postprandial blood glucose concentrations to the high energy density meal (i.e. the pasticcio meal).
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Piechowiak K, Dżygało K, Szypowska A. The additional dose of insulin for high-protein mixed meal provides better glycemic control in children with type 1 diabetes on insulin pumps: randomized cross-over study. Pediatr Diabetes 2017; 18:861-868. [PMID: 28117542 DOI: 10.1111/pedi.12500] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/26/2016] [Accepted: 12/16/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Delivery of insulin for high-protein low-fat meals with carbohydrates on the basis of carbohydrates leads to higher late postprandial glycemia. Studies with mixed meals demonstrated lower blood glucose level after dual wave bolus. The objective of our study was to assess the impact of additional dose of insulin in dual wave bolus for high-protein mixed meal on the postprandial glycemia. MATERIALS AND METHODS We performed a randomized, double-blind, two-way cross-over study, including 58 children with type 1 diabetes, aged 14.7 ± 2.2 years. Participants were randomly assigned into two treatment orders: NORMAL-DUAL or DUAL-NORMAL BOLUS. They consumed standardized high-protein, low-fat meals with carbohydrates. The primary outcome was postprandial glycemia (PPG) based on capillary blood glucose measurements (CBGM). The secondary outcomes were the frequency of hypoglycemia, area under glucose curve, mean amplitude of glycemic excursion (MAGE) and glycemic rise. RESULTS PPG assessed at 180 min was significantly lower when dual wave bolus was delivered (NORMAL 162 mg/dL [9 mmol/L] vs DUAL 130.0 mg/dL [7.22 mmol/L]; P = .004). There were no differences in CBGM between both groups at 60 and 120 min. We found differences between the groups in MAGE at 120 min (NORMAL 82.86 mg/dL [4.6 mmol/L] versus DUAL 54.76 mg/dL [3.04 mmol/L]; P = .0008). We observed no differences in the number of hypoglycemic episodes in both groups. CONCLUSION Applying an additional dose of insulin in dual wave bolus for high-protein mixed meal improved PPG. We observed no statistically significant increase in the number of hypoglycemic episodes associated with this intervention.
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Affiliation(s)
| | - Katarzyna Dżygało
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
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Paterson MA, Smart CEM, Lopez PE, McElduff P, Attia J, Morbey C, King BR. Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy. Diabet Med 2016; 33:592-8. [PMID: 26499756 PMCID: PMC5064639 DOI: 10.1111/dme.13011] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 01/30/2023]
Abstract
AIM To determine the effects of protein alone (independent of fat and carbohydrate) on postprandial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy. METHODS Participants with Type 1 diabetes mellitus aged 7-40 years consumed six 150 ml whey isolate protein drinks [0 g (control), 12.5, 25, 50, 75 and 100] and two 150 ml glucose drinks (10 and 20 g) without insulin, in randomized order over 8 days, 4 h after the evening meal. Continuous glucose monitoring was used to assess postprandial glycaemia. RESULTS Data were collected from 27 participants. Protein loads of 12.5 and 50 g did not result in significant postprandial glycaemic excursions compared with control (water) throughout the 300 min study period (P > 0.05). Protein loads of 75 and 100 g resulted in lower glycaemic excursions than control in the 60-120 min postprandial interval, but higher excursions in the 180-300 min interval. In comparison with 20 g glucose, the large protein loads resulted in significantly delayed and sustained glucose excursions, commencing at 180 min and continuing to 5 h. CONCLUSIONS Seventy-five grams or more of protein alone significantly increases postprandial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy. The glycaemic profiles resulting from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion. This research supports recommendations for insulin dosing for large amounts of protein.
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Affiliation(s)
- M A Paterson
- Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia
- Faculty of Health, School of Medicine, University of Newcastle, NSW, Australia
| | - C E M Smart
- Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - P E Lopez
- Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia
- Faculty of Health, School of Medicine, University of Newcastle, NSW, Australia
| | - P McElduff
- Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia
| | - J Attia
- Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, NSW, Australia
| | - C Morbey
- Aim Diabetes Management Centre, Newcastle, NSW, Australia
| | - B R King
- Faculty of Health, School of Medicine, University of Newcastle, NSW, Australia
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia
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Algorithms to Improve the Prediction of Postprandial Insulinaemia in Response to Common Foods. Nutrients 2016; 8:210. [PMID: 27070641 PMCID: PMC4848679 DOI: 10.3390/nu8040210] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 12/21/2022] Open
Abstract
Dietary patterns that induce excessive insulin secretion may contribute to worsening insulin resistance and beta-cell dysfunction. Our aim was to generate mathematical algorithms to improve the prediction of postprandial glycaemia and insulinaemia for foods of known nutrient composition, glycemic index (GI) and glycemic load (GL). We used an expanded database of food insulin index (FII) values generated by testing 1000 kJ portions of 147 common foods relative to a reference food in lean, young, healthy volunteers. Simple and multiple linear regression analyses were applied to validate previously generated equations for predicting insulinaemia, and develop improved predictive models. Large differences in insulinaemic responses within and between food groups were evident. GL, GI and available carbohydrate content were the strongest predictors of the FII, explaining 55%, 51% and 47% of variation respectively. Fat, protein and sugar were significant but relatively weak predictors, accounting for only 31%, 7% and 13% of the variation respectively. Nutritional composition alone explained only 50% of variability. The best algorithm included a measure of glycemic response, sugar and protein content and explained 78% of variation. Knowledge of the GI or glycaemic response to 1000 kJ portions together with nutrient composition therefore provides a good approximation for ranking of foods according to their “insulin demand”.
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Bell KJ, Gray R, Munns D, Petocz P, Steil G, Howard G, Colagiuri S, Brand-Miller JC. Clinical Application of the Food Insulin Index for Mealtime Insulin Dosing in Adults with Type 1 Diabetes: A Randomized Controlled Trial. Diabetes Technol Ther 2016; 18:218-25. [PMID: 26840067 DOI: 10.1089/dia.2015.0254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Food Insulin Index (FII) is a novel algorithm for ranking foods based on their insulin demand relative to an isoenergetic reference food. We compared the effect of carbohydrate counting (CC) versus the FII algorithm for estimating insulin dosage on glycemic control in type 1 diabetes. MATERIALS AND METHODS In a randomized, controlled trial, adults (n = 26) using insulin pump therapy were assigned to using either traditional CC or the novel Food Insulin Demand (FID) counting for 12 weeks. Subjects participated in group education and individual sessions. At baseline and on completion of the trial, glycated hemoglobin A1c (HbA1c), day-long glycemia (6-day continuous glucose monitoring), fasting lipids, and C-reactive protein were determined. RESULTS Changes in HbA1c from baseline to 12 weeks were small and not significant in both groups (mean ± SEM; FII vs. CC, -0.1 ± 0.1% vs. -0.3 ± 0.2%; P = 0.855). The incremental area under the curve following breakfast declined significantly among the FID counters with no change in the CC group (FID vs. CC, -93 ± 41 mmol/L/min [P = 0.043] vs. 4 ± 50 mmol/L/min [P = 0.938]; between groups, P = 0.143). The mean amplitude of the glycemic excursion (MAGE) was significantly reduced among the FID counters (FID vs. CC, -6.1 ± 1.0 vs. -1.3 ± 1.0 mmol/L; P = 0.003), and only the FID counters experienced a trend (-44% vs. +11%; P = 0.057) to reduced hypoglycemia. CONCLUSIONS In a 12-week pilot study, MAGE and postprandial glycemia following breakfast were significantly improved with FII counting versus CC, despite no significant differences in HbA1c.
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Affiliation(s)
- Kirstine J Bell
- 1 Charles Perkins Centre, The University of Sydney , Sydney, New South Wales, Australia
- 2 School of Molecular Bioscience, The University of Sydney , Sydney, New South Wales, Australia
| | - Robyn Gray
- 3 Sydney Insulin Pump Clinic , Sydney, New South Wales, Australia
| | - Diane Munns
- 3 Sydney Insulin Pump Clinic , Sydney, New South Wales, Australia
| | - Peter Petocz
- 4 Department of Statistics, Macquarie University , Sydney, New South Wales, Australia
| | - Garry Steil
- 5 Harvard Medical School , Boston, Massachusetts
- 6 Children's Hospital , Boston, Massachusetts
| | - Gabrielle Howard
- 3 Sydney Insulin Pump Clinic , Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- 1 Charles Perkins Centre, The University of Sydney , Sydney, New South Wales, Australia
- 2 School of Molecular Bioscience, The University of Sydney , Sydney, New South Wales, Australia
| | - Jennie C Brand-Miller
- 1 Charles Perkins Centre, The University of Sydney , Sydney, New South Wales, Australia
- 2 School of Molecular Bioscience, The University of Sydney , Sydney, New South Wales, Australia
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Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA. Impact of fat, protein, and glycemic index on postprandial glucose control in type 1 diabetes: implications for intensive diabetes management in the continuous glucose monitoring era. Diabetes Care 2015; 38:1008-15. [PMID: 25998293 DOI: 10.2337/dc15-0100] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Continuous glucose monitoring highlights the complexity of postprandial glucose patterns present in type 1 diabetes and points to the limitations of current approaches to mealtime insulin dosing based primarily on carbohydrate counting. METHODS A systematic review of all relevant biomedical databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, was conducted to identify research on the effects of dietary fat, protein, and glycemic index (GI) on acute postprandial glucose control in type 1 diabetes and prandial insulin dosing strategies for these dietary factors. RESULTS All studies examining the effect of fat (n = 7), protein (n = 7), and GI (n = 7) indicated that these dietary factors modify postprandial glycemia. Late postprandial hyperglycemia was the predominant effect of dietary fat; however, in some studies, glucose concentrations were reduced in the first 2-3 h, possibly due to delayed gastric emptying. Ten studies examining insulin bolus dose and delivery patterns required for high-fat and/or high-protein meals were identified. Because of methodological differences and limitations in experimental design, study findings were inconsistent regarding optimal bolus delivery pattern; however, the studies indicated that high-fat/protein meals require more insulin than lower-fat/protein meals with identical carbohydrate content. CONCLUSIONS These studies have important implications for clinical practice and patient education and point to the need for research focused on the development of new insulin dosing algorithms based on meal composition rather than on carbohydrate content alone.
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Affiliation(s)
- Kirstine J Bell
- Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, Australia Joslin Diabetes Center, Boston, MA
| | - Carmel E Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, Australia
| | - Garry M Steil
- Children's Hospital, Boston, MA Harvard Medical School, Boston, MA
| | - Jennie C Brand-Miller
- Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, Australia
| | - Bruce King
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, Australia
| | - Howard A Wolpert
- Joslin Diabetes Center, Boston, MA Harvard Medical School, Boston, MA
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Bell KJ, Gray R, Munns D, Petocz P, Howard G, Colagiuri S, Brand-Miller JC. Estimating insulin demand for protein-containing foods using the food insulin index. Eur J Clin Nutr 2014; 68:1055-9. [PMID: 25005674 DOI: 10.1038/ejcn.2014.126] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/18/2014] [Accepted: 05/20/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE The Food Insulin Index (FII) is a novel algorithm for ranking foods on the basis of insulin responses in healthy subjects relative to an isoenergetic reference food. Our aim was to compare postprandial glycemic responses in adults with type 1 diabetes who used both carbohydrate counting and the FII algorithm to estimate the insulin dosage for a variety of protein-containing foods. SUBJECTS/METHODS A total of 11 adults on insulin pump therapy consumed six individual foods (steak, battered fish, poached eggs, low-fat yoghurt, baked beans and peanuts) on two occasions in random order, with the insulin dose determined once by the FII algorithm and once with carbohydrate counting. Postprandial glycemia was measured in capillary blood glucose samples at 15-30 min intervals over 3 h. Researchers and participants were blinded to treatment. RESULTS Compared with carbohydrate counting, the FII algorithm significantly reduced the mean blood glucose level (5.7±0.2 vs 6.5±0.2 mmol/l, P=0.003) and the mean change in blood glucose level (-0.7±0.2 vs 0.1±0.2 mmol/l, P=0.001). Peak blood glucose was reached earlier using the FII algorithm than using carbohydrate counting (34±5 vs 56±7 min, P=0.007). The risk of hypoglycemia was similar in both treatments (48% vs 33% for FII vs carbohydrate counting, respectively, P=0.155). CONCLUSIONS In adults with type 1 diabetes, compared with carbohydrate counting, the novel FII algorithm improved postprandial hyperglycemia after consumption of protein-containing foods.
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Affiliation(s)
- K J Bell
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - R Gray
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - D Munns
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - P Petocz
- Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - G Howard
- Sydney Insulin Pump Clinic, Sydney, NSW, Australia
| | - S Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
| | - J C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, School of Molecular Bioscience, The University of Sydney, Sydney, NSW, Australia
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Wiley J, Westbrook M, Long J, Greenfield JR, Day RO, Braithwaite J. Diabetes education: the experiences of young adults with type 1 diabetes. Diabetes Ther 2014; 5:299-321. [PMID: 24519150 PMCID: PMC4065294 DOI: 10.1007/s13300-014-0056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Clinician-led diabetes education is a fundamental component of care to assist people with Type 1 diabetes (T1D) self-manage their disease. Recent initiatives to incorporate a more patient-centered approach to diabetes education have included recommendations to make such education more individualized. Yet there is a dearth of research that identifies patients' perceptions of clinician-led diabetes education. We aimed to describe the experience of diabetes education from the perspective of young adults with T1D. METHODS We designed a self-reported survey for Australian adults, aged 18-35 years, with T1D. Participants (n = 150) were recruited by advertisements through diabetes consumer-organizations. Respondents were asked to rate aspects of clinician-led diabetes education and identify sources of self-education. To expand on the results of the survey we interviewed 33 respondents in focus groups. RESULTS SURVEY The majority of respondents (56.0%) were satisfied with the amount of continuing clinician-led diabetes education; 96.7% sought further self-education; 73.3% sourced more diabetes education themselves than that provided by their clinicians; 80.7% referred to diabetes organization websites for further education; and 30.0% used online chat-rooms and blogs for education. Focus groups: The three key themes that emerged from the interview data were deficiencies related to the pedagogy of diabetes education; knowledge deficiencies arising from the gap between theoretical diabetes education and practical reality; and the need for and problems associated with autonomous and peer-led diabetes education. CONCLUSION Our findings indicate that there are opportunities to improve clinician led-diabetes education to improve patient outcomes by enhancing autonomous health-literacy skills and to incorporate peer-led diabetes education and support with clinician-led education. The results provide evidence for the potential value of patient engagement in quality improvement and health-service redesign.
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Affiliation(s)
- Janice Wiley
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia,
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Bell KJ, Barclay AW, Petocz P, Colagiuri S, Brand-Miller JC. Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2014; 2:133-40. [PMID: 24622717 DOI: 10.1016/s2213-8587(13)70144-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although carbohydrate counting is the recommended dietary strategy for achieving glycaemic control in people with type 1 diabetes, the advice is based on narrative review and grading of the available evidence. We aimed to assess by systematic review and meta-analysis the efficacy of carbohydrate counting on glycaemic control in adults and children with type 1 diabetes. METHODS We screened and assessed randomised controlled trials of interventions longer than 3 months that compared carbohydrate counting with general or alternate dietary advice in adults and children with type 1 diabetes. Change in glycated haemoglobin (HbA1c) concentration was the primary outcome. The results of clinically and statistically homogenous studies were pooled and meta-analysed using the random-effects model to provide estimates of the efficacy of carbohydrate counting. FINDINGS We identified seven eligible trials, of 311 potentially relevant studies, comprising 599 adults and 104 children with type 1 diabetes. Study quality score averaged 7·6 out of 13. Overall there was no significant improvement in HbA1c concentration with carbohydrate counting versus the control or usual care (-0·35% [-3·9 mmol/mol], 95% CI -0·75 to 0·06; p=0·096). We identified significant heterogeneity between studies, which was potentially related to differences in study design. In the five studies in adults with a parallel design, there was a 0·64% point (7·0 mmol/mol) reduction in HbA1c with carbohydrate counting versus control (95% CI -0·91 to -0·37; p<0·0001). INTERPRETATION There is some evidence to support the recommendation of carbohydrate counting over alternate advice or usual care in adults with type 1 diabetes. Additional studies are needed to support promotion of carbohydrate counting over other methods of matching insulin dose to food intake. FUNDING None.
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Affiliation(s)
- Kirstine J Bell
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, and the School of Molecular Bioscience, University of Sydney, Sydney, NSW, Australia
| | - Alan W Barclay
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, and the School of Molecular Bioscience, University of Sydney, Sydney, NSW, Australia; Australian Diabetes Council, Sydney, NSW, Australia
| | - Peter Petocz
- Department of Statistics, Macquarie University, Sydney, NSW, Australia
| | - Stephen Colagiuri
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, and the School of Molecular Bioscience, University of Sydney, Sydney, NSW, Australia
| | - Jennie C Brand-Miller
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, and the School of Molecular Bioscience, University of Sydney, Sydney, NSW, Australia.
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Rossetti P, Ampudia-Blasco FJ, Laguna A, Revert A, Vehì J, Ascaso JF, Bondia J. Evaluation of a novel continuous glucose monitoring-based method for mealtime insulin dosing--the iBolus--in subjects with type 1 diabetes using continuous subcutaneous insulin infusion therapy: a randomized controlled trial. Diabetes Technol Ther 2012; 14:1043-52. [PMID: 23003329 PMCID: PMC3482847 DOI: 10.1089/dia.2012.0145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Prandial insulin dosing is an empirical practice associated frequently with poor reproducibility in postprandial glucose response. Based on continuous glucose monitoring (CGM), a method for prandial insulin administration (iBolus) is presented and evaluated for people with type 1 diabetes using CSII therapy. SUBJECTS AND METHODS An individual patient's model for a 5-h postprandial period was obtained from 6-day ambulatory CGM and used for iBolus calculation in 12 patients with type 1 diabetes. In a double-blind, crossover study each patient underwent four meal tests with 40 g or 100 g of carbohydrates (CHOs), both on two occasions. For each meal, the iBolus or the traditional bolus (tBolus) was given before mealtime (t(0)) in a randomized order. We measured the postprandial glycemic response as the area under the curve of plasma glucose (AUC-PG(0-5h)) and variability as the individual coefficient of variation (CV) of AUC-PG(0-5h). The contribution of the insulin-to-CHO ratio, CHO, plasma glucose at t(0) (PG(t0)), and insulin dose to AUC-PG(0-5h) and its CV was also investigated. RESULTS AUC-PG(0-5h) was similar with either bolus for 40-g (iBolus vs. tBolus, 585.5±127.5 vs. 689.2±180.7 mg/dL·h) or 100-g (752.1±237.7 vs. 760.0±263.2 mg/dL·h) CHO meals. A multiple regression analysis revealed a significant model only for the tBolus, with PG(t0) being the best predictor of AUC-PG(0-5h) explaining approximately 50% of the glycemic response. Observed variability was greater with the iBolus (CV, 16.7±15.3% vs. 10.1±12.5%) but independent of the factors studied. CONCLUSIONS A CGM-based algorithm for calculation of prandial insulin is feasible, although it does not reduce unpredictability of individual glycemic responses. Causes of variability need to be identified and analyzed for further optimization of postprandial glycemic control.
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Affiliation(s)
- Paolo Rossetti
- University Institute of Control Systems and Industrial Computing, Polytechnic University of Valencia, Valencia, Spain.
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Bao J, Gilbertson HR, Gray R, Munns D, Howard G, Petocz P, Colagiuri S, Brand-Miller JC. Improving the estimation of mealtime insulin dose in adults with type 1 diabetes: the Normal Insulin Demand for Dose Adjustment (NIDDA) study. Diabetes Care 2011; 34:2146-51. [PMID: 21949219 PMCID: PMC3177729 DOI: 10.2337/dc11-0567] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although carbohydrate counting is routine practice in type 1 diabetes, hyperglycemic episodes are common. A food insulin index (FII) has been developed and validated for predicting the normal insulin demand generated by mixed meals in healthy adults. We sought to compare a novel algorithm on the basis of the FII for estimating mealtime insulin dose with carbohydrate counting in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 28 patients using insulin pump therapy consumed two different breakfast meals of equal energy, glycemic index, fiber, and calculated insulin demand (both FII = 60) but approximately twofold difference in carbohydrate content, in random order on three consecutive mornings. On one occasion, a carbohydrate-counting algorithm was applied to meal A (75 g carbohydrate) for determining bolus insulin dose. On the other two occasions, carbohydrate counting (about half the insulin dose as meal A) and the FII algorithm (same dose as meal A) were applied to meal B (41 g carbohydrate). A real-time continuous glucose monitor was used to assess 3-h postprandial glycemia. RESULTS Compared with carbohydrate counting, the FII algorithm significantly decreased glucose incremental area under the curve over 3 h (-52%, P = 0.013) and peak glucose excursion (-41%, P = 0.01) and improved the percentage of time within the normal blood glucose range (4-10 mmol/L) (31%, P = 0.001). There was no significant difference in the occurrence of hypoglycemia. CONCLUSIONS An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes.
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Affiliation(s)
- Jiansong Bao
- Boden Institute of Obesity, Nutrition & Exercise and the School of Molecular Biosciences, University of Sydney, Sydney, Australia
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