Glycemic profile is improved by High Slowly Digestible Starch diet in type 2 diabetic patients

Abstract

<jats:title>Abstract</jats:title><jats:sec id="S0029665120001135_sec_a1" sec-type="intro"><jats:title>Introduction</jats:title><jats:p>Considering the dramatically increasing incidence of type 2 diabetes (T2D), decreasing glycemic variability in T2D patients is a key challenge to limit the occurrence of diabetic complications. Diet appears as one potential lever that can be set up above medications. Particularly, the ingestion of foods with a high content in slowly digestible starch (SDS) demonstrated both lower postprandial glycemic and insulin responses in healthy and insulin resistant subjects. This study aimed at designing a full high-SDS diet by selecting high-SDS starchy food products and at studying its impact on glycemic response and variability in T2D.</jats:p></jats:sec><jats:sec id="S0029665120001135_sec_a2" sec-type="materials"><jats:title>Materials and methods</jats:title><jats:p>This pilot randomized controlled cross-over study included eight T2D patients (HbA1c = 7.0 ± 0.2%, BMI = 31.7 ± 2.1 kg/m<jats:sup>2</jats:sup>, treated by Metformin &amp; Sitagliptin) who consumed twice, for one week a controlled diet containing starchy food products screened and selected to be either High (High-SDS) or Low (Low-SDS) in SDS, as determined by the SDS <jats:italic>in-vitro</jats:italic> method developed by Englyst et al. During each diet period, the glycemic profile was monitored for 6 days using a Continuous Glucose Monitoring System (CGMS). Multiple metrics related to variability and glycemic responses were calculated.</jats:p></jats:sec><jats:sec id="S0029665120001135_sec_a3" sec-type="results"><jats:title>Results</jats:title><jats:p>222 SDS analyses were realized on commercial food products as consumed. 23 High-SDS and 20 Low-SDS food items with associated specific cooking instructions were selected to design two diets consistent with local T2D recommendations. The High-SDS diet demonstrated a significantly higher SDS content compared to the Low-SDS diet (61.6 vs 11.6 g/day; p &lt; 0.0001), mainly driven by selected pasta, rice and high-SDS biscuits (75.6% of the consumed SDS content). The % of total daily energy intake (TDEI) for all macronutrients remained similar between diets (p &gt; 0.05) and the carbohydrate content specifically represented 49 ± 1 % and 47 ± 2 % of the TDEI for High-SDS and Low-SDS diets, respectively. With the high-SDS diet, the Mean Amplitude of Glycemic Excursion, a key parameter of glycemic variability, was significantly decreased (79.6 for Low-SDS vs 61.6 mg/dL for High-SDS; p = 0.0067). The significant correlation between the meals SDS contents and various glycemic parameters such as postprandial iAUC, tAUC (up to 180 min) or peak value strengthen this finding (p &lt; 0.05 for all).</jats:p></jats:sec><jats:sec id="S0029665120001135_sec_a4" sec-type="discussion"><jats:title>Discussion</jats:title><jats:p>It was the first demonstration that a diet including selected starchy food items and cooking recommendations designed to favor products’ high SDS content beneficially impacts glycemic profile in T2D subjects. Carefully selecting starchy food may be a simple and valuable tool to improve glycemic control in T2D.</jats:p></jats:sec>

Structural and physicochemical properties of rice starch from a variety with high resistant starch and low amylose content

“…SDS helps to maintain stable blood glucose levels, therefore reducing feelings of hunger. In a test of an SDS-enriched diet, Gou et al ( 29 ) found that insulin-resistant subjects showed lower postprandial glucose and insulin responses and that SDS had a significant effect on improving insulin sensitivity. During processing, increasing the SDS and RS content of the product reduces starch digestibility and can improve the nutritional quality of the grain ( 30 ).…”