A Comparison of Carbohydrate Metabolism After Sucrose, Sorbitol, and Fructose Meals in Normal and Diabetic Subjects

Abstract

Sucrose, sorbitol, and fructose (35 g) were fed to normal and diabetic subjects as a component of a 400-calorie breakfast. In both normal and diabetic subjects, the mean peak increment in plasma glucose was highest after the sucrose meals (44.0 mg/dl for normal subjects; 78.0 mg/dl for diabetic subjects); lowest after sorbitol meals (9.3 mg/dl for normal subjects; 32.3 mg/dl for diabetic subjects); and intermediate after the fructose meals (29.0 mg/dl for normal subjects; 48.0 mg/dl for diabetic subjects). In normal subjects, the mean peak increment of plasma immunoreactive insulin followed a similar pattern, but in diabetic subjects there was no significant difference between the three groups. We conclude that fructose or sorbitol, given as part of a meal, results in lower glucose levels in both normal and diabetic subjects, but that the latter is not related to a difference in insulin release.

Metabolic Effects of Dietary Fructose in Diabetic Subjects

“…Of the foods tested, fructose had one of the lowest glycemic indexes. Consistent with this, when diabetic subjects consumed fructose alone (3,4), as part of a snack (5), or as part of a meal (3,(6)(7)(8), the postprandial increases in plasma glucose were lesser than those produced by isocaloric amounts of other carbohydrates. However, studies that have attempted to quantitate the effects of chronic fructose consumption on glycemia have yielded less conclusive results.…”

“…Whether or not it is advisable for people with diabetes to consume fructose in these amounts is not clear. Fructose has a low glycemic index (2), and when diabetic subjects consumed fructose alone (3,4) or as part of a snack (5) or meal (3,(6)(7)(8), the postprandial increases in plasma glucose were lesser than those produced by isocaloric amounts of other carbohydrates. Recognizing this, the American Diabetes Association has stated in its nutritional recommendations that dietary fructose is acceptable in the management of diabetes, while acknowledging that the metabolic effects of chronic ingestion of diets containing fructose by people with diabetes need further study (9).…”

Nutritional management of diabetes mellitus: rationale, ethics and practicability.

“…The palatability and the favorable effects of fructose on blood glucose control, insulin sensitivity, plasma level of lipids, uric acid, and lactates have been shown over a short period in diabetics [63][64][65][66][67][68]. However, long-term effects have not been studied in diabetics.…”

Clinical Aspects of Sucrose and Fructose Metabolism

“…Whereas sucrose does not aggravate hyperglycemia, fructose may have definite advantages when used as a sweetening agent in the diabetic diet. When diabetic subjects consumed fructose alone or as part of a meal, the postprandial increases in plasma glucose levels were less than those produced by isocaloric amounts of other common carbohydrates (3,5,8). All of these studies, however, only evaluated responses to a single meal and thus did not document long-term safety of either sucrose or fructose.…”