Effects of Different Proportion of Carbohydrate in Breakfast on Postprandial Glucose Excursion in Normal Glucose Tolerance and Impaired Glucose Regulation Subjects

Abstract

Background: The variability of postprandial plasma glucose is an independent risk factor for diabetes. The type and amount of carbohydrate may be important determinants of glycemic control. The aim of the study was to compare the effects of different proportions of carbohydrate in breakfast on postprandial blood glucose fluctuations in impaired glucose regulation (IGR) and normal glucose tolerance (NGT) subjects. Subjects and Methods: This is a cross-sectional study of two groups including 55 subjects with IGR and 78 individuals with NGT. Their recorded breakfast was sorted into low-carbohydrate (LC) (carbohydrate < 45%), medium-carbohydrate (MC) (carbohydrate 45-65%), and high-carbohydrate (HC) (carbohydrate > 65%) meals according to the proportion of carbohydrate. Glucose concentrations were continuously measured with a continuous glucose monitoring system, and parameters such as the incremental area under the curve (iAUC) of glucose and postprandial glucose excursion (PPGE) were calculated to evaluate postprandial glucose fluctuations. Results: The postprandial fluctuations of glucose increased gradually with increased proportions of carbohydrate in breakfast in both IGR and NGT subjects. For the MC and HC meals, iAUC, PPGE, postprandial glucose spike (PGS), and mean blood glucose were significantly greater than those in the NGT group (P < 0.05), respectively. The median time to PGS and the time period in which glucose concentrations decreased to baseline after the MC and HC meals in the IGR group were significantly longer than those in the NGT group (P < 0.01), respectively. Compared with the NGT subjects for the HC meal, the IGR subjects consuming the MC meal had greater PGS, range of glucose concentrations, SD, and PPGE (P < 0.05). Conclusions: The proportion of carbohydrate in breakfast contributes to glucose excursions in the NGT and IGR subjects. In the IGR subjects, a HC meal should be avoided and a LC meal should be recommended to prevent development of diabetes.

Postprandial dysmetabolism: Too early or too late?

“…128,129 In addition, it seems that consumption of meals containing high amounts of carbohydrates contributes to post-meal glucose excursions in individuals both with impaired glucose regulation and with normal glucose tolerance, with postprandial glucose fluctuations increasing gradually with increased proportions of consumed carbohydrates. 130 The ESC and the EAS Guidelines for the management of dyslipidemias state that a high monounsaturated fat diet significantly improves insulin sensitivity and reduces postprandial TG levels compared to a high saturated fat diet. 154 There is evidence that consumption of omega-3 fatty acids may improve postprandial lipid metabolism, curbing elevations of triglycerides, ApoB48, remnant lipoprotein-cholesterol levels in healthy subjects, decreasing postprandial triglyceride and ApoB48 in obese individuals combined with an hypocaloric diet and reducing postprandial triacylglycerol levels in hypertriglyceridemic patients.…”

Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008–2016

“…It has been hypothesized that lower postprandial glucose excursion on a low-carbohydrate, high-fat (LCHF) diet may lead to a better glucose control [7,8]. LCHF diets have been promoted as a possible strategy for the management and prevention of T2DM, but there is no consensus on the best macronutrient composition [9].…”

Chinese clinical guidelines for continuous glucose monitoring (2018 edition)

“… Retrospective CGM is mainly applicable to the following patients or conditions: type 1 diabetes patients; type 2 diabetes patients who need intensive insulin therapy (eg, subcutaneous insulin injection three times or more per day or use of an insulin pump); type 2 diabetes patients who use hypoglycemic therapy under the guidance of SMBG but still have one of the following situations: unexplainable severe hypoglycemia or recurrent hypoglycemia, asymptomatic hypoglycemia or nocturnal hypoglycemia; unexplainable hyperglycemia, especially fasting hyperglycemia; dramatic glycemic variability; those patients who deliberately maintain their blood glucose at high levels due to fear of hypoglycemia; type 2 diabetes patients whose HbA 1c is above target but are not responding to multidrug oral and/or non‐insulin injectable therapies. gestational diabetes patients and women with diabetes during pregnancy; diabetes education. CGM facilitates the understanding of glucose changes resulting from diet, exercise, drinking, stress, sleep, and hypoglycemic treatment, thus motivating patients to establish a healthy lifestyle, improving patients' adherence to treatment, and leading to effective communication between clinicians and patients. other clinical situations such as diabetes patients with gastroparesis, special types of diabetes, or endocrine disorders accompanied by dramatic glycemic variability Overall, CGM is primarily recommended to patients with type 1 diabetes and those with type 2 diabetes on intensive insulin therapy or who experience dramatic glycemic variability.…”