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The efficacy of multigrain flatbread in regulating the lipid profile and carbohydrate homeostasis among type 2 diabetic patients was studied in 100 type 2 diabetic participants. The results revealed that the anthropometric parameters remained unaltered in both test and control groups. The fasting blood glucose levels (140.70 ± 8.43 versus 132.89 ± 5.63 mg/dl) did not significantly decrease. In contrast, the insulin levels (12.96 ± 1.06 versus 10.83 ± 1.03 μIU/ml) and HbA1c levels (8.01 ± 0.27 versus 7.40 ± 0.21%) in the test group decreased significantly, and it was associated with a decrease in insulin resistance. The LDL levels in the test group decreased after the intervention (116.0 ± 5.67 versus 98.7 ± 5.68 mg/dl), while triglycerides and VLDL increased significantly and HDL levels remained unaltered. A significant decrease in average blood pressure (systolic/diastolic) was noticed among the test group participants. The human RBP4 and hs-CRP remained unaltered. Practical applications Millets are rich in fibers, has complex carbohydrate, protein, and is lower in fat content. Millets provide a wide range of nutrients, phytochemicals, and are gluten-free with low glycemic nature. Their intake can reduce factors such as insulin resistance and oxidative stress responsible for the pathogenesis of type 2 diabetes and cardiovascular diseases. Our study indicated the use of multigrain flatbreads prepared from millets helped reduce serum insulin, LDL cholesterol, HbA1c levels, and incidentally blood pressure levels with a significant increase in insulin sensitivity in type 2 diabetes participants. The results suggest using the multigrain flatbread meal as a food supplement or meal replacer in diabetic participants in terms of glucose control and insulin sensitivity. K E Y W O R D S blood glucose, glycosylated hemoglobin, multigrain roti, type 2 diabetes How to cite this article: Sobhana PP, Kandlakunta B, Nagaraju R, et al. Human clinical trial to assess the effect of consumption of multigrain Indian bread on glycemic regulation in type 2 diabetic participants.

Whole grain-based foods have been shown to reduce the risk of development of metabolic syndrome. In this study, we formulated whole grain-based multigrain flour and analyzed for available carbohydrate content, glycemic index (GI), and sensory evaluation. The multigrain flour composition 1 (C1) and composition 2 (C2) were formulated using defatted soya or bengal gram as a source of protein along with millets (40∼45%) and whole cereals. The proximate composition was calculated using Indian food composition tables. The microbial load and free fatty acid contents were analyzed in flour samples that were stored for different durations. The total dietary fiber, protein, and carbohydrate contents per 100 g of C1 and C2 flours were in the range of 11∼14, 13∼15, and 60 g, respectively. The available carbohydrate content in C1 and C2 were 55.4 and 62.3 g, and the in vivo GI was 63.2 and 66.2%, respectively. The acceptability scores of C1 and C2 products were in the range of 3.38 to 3.39 on the 5 points Hedonic scale. The multigrain flours were stable for 3 months based on microbial load and rancidity. The observed GIs of the multigrain flour were much lower than that of commercial refined wheat products. Therefore, these products may be recommended to regular diet plans to help prevent and/or ameliorate metabolic syndrome in the general population.

Development of low glycemic-foods is important in the prevention and management of type 2 diabetes. In this context, we prepared four test foods (TFs) (two mixed mini-meals and two breakfast items) with low glycemic-components and assessed their glycemic index (GI) in young healthy non-diabetic volunteers with mean age of 29 yr, body mass index of 24 kg/m2, and fasting plasma glucose levels less than 4.62 mmol/L. Volunteers were given 50 g of glucose, as a reference food (RF) on the first day, and TFs, i.e. TF1 (mixed mini meal: roti made of wheat flour and chana dal+ curd), TF2 [mixed mini meal made of wheat, pearl barley, and Bengal gram flour (besan) mix with chana whole (unhusked chana+curd)], TF3 (pearl barley rawa upma), and TF4 (wheat rawa upma) were given 2-day intervals in the same order. Glucose levels at fasting conditions and after the consumption of RF and TFs at different time intervals (15, 30, 45, 60, 90, and 120 min) were measured, and the incremental area under curve (IAUC) for glucose and GI of the TFs were calculated. The glucose IAUC values at different time points were highest for TF2 (GI=71.9±7.4), while all other TFs had comparable GI in the range of 53.7~54.9. Among the various TFs, TF1, TF3, and TF4 exerted low to moderate glycemic response, and thus can be classified as low glycemic-foods. Nevertheless, these foods need to be tested for their efficacy in controlling and/or managing hyperglycemia and glucose over-load in diabetic subjects.

Nutritional intervention is a key strategy in the control and management of non-communicable diseases. Here, initially, we evaluated the effects of carrot juice (CJ) on some of the physical and biochemical parameters in rats fed with high-fructose diet, then in type 2 diabetic subjects. For the animal study, weanling male Wistar rats were given control (n = 6) or high fructose (HFr; n = 24) diet for 8 weeks. Then, the HFr group rats were subdivided into 4 groups (n = 6 in each) and continued either on HFr diet or shifted to control diet, with or without CJ (0.3 mg β-carotene) ingestion orally for 8 weeks. At the end, the ingestion of CJ reversed the HFr-induced adiposity (23 ± 1.6 vs 18 ± 1.1, P = .038), hypertriglyceridemia (182 ± 18.2 vs 90 ± 10.5 mg/dL, P<0.001), and hyperinsulinemia (81 ± 14.7 vs 40 ± 7.5 µU/mL, P = .014), while increased the retinol levels in liver (240 ± 38.4 vs 492 ± 61.2 µg/g, P = .002) and adipose tissue (1.8 ± 0.09 vs 2.5 ± 0.18 µg/g, P = .026). On the other hand, in the diabetic subjects (7 males and females each, n = 14) compared to their baseline, the daily consumption of 50 mL CJ (~2400 µg β-carotene) for 6 weeks significantly reduced the body weight (69.4 ± 4.13 vs 69.0 ± 4.09 kg, P = .014), BMI (27.4 ± 1.07 vs 27.2 ± 1.06 kg/m2, P = .007), and fat% (33.4 ± 1.87 vs 31.9 ± 2.13, P = .029) with an increase in plasma β-carotene levels (0.21 ± 0.045 vs 0.45 ± 0.089 µmol/L, P = .044). Although CJ increased the glucose (145 ± 10.4 vs 165 ± 11.4 mg/dL, P = .039), insulin, and glycated hemoglobin levels remained unaltered. In conclusion, the consumption of carrot juice reversed the HFr-induced metabolic abnormalities in a rat model and decreased body weight and BMI of diabetic subjects.