Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial

Abstract

Objective:To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. Subjects and methods: The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. Results: Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. Conclusions: Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration:

Fruitarian Diet and Blood Glucose Control in Type 1 Diabetes: A Case Report

“…As for blood glucose control, it has been shown that fructose is a slow digestible carbohydrate that induces a lower postprandial blood glucose response than glucose in individuals with type 1 diabetes ( 12 , 13 ). This could explain the reduction in glucose variability in the first 3 months of the fruitarian diet.…”

Nutritional Recommendations for People with Type 1 Diabetes Mellitus

“…Furthermore, fructose is converted to free fatty acids during de novo lipogenesis, but only to a small proportion of about 1-5 % [48]. Systematic reviews and meta-analyses, which included individuals with T1Dm, as well as a randomized controlled trial with T1Dm patients, show lower postprandial peaks for blood glucose, lower total cholesterol concentrations, no differences in other serum lipid parameters, but possibly increased uric acid concentrations and oxidative stress in an isocaloric comparison of fructose with other carbohydrates [49][50][51][52]. Due to the hepatic metabolization of fructose, its influence on hepatic insulin sensitivity is also widely discussed.…”

Empfehlungen zur Ernährung von Personen mit Typ-1-Diabetes mellitus

“…Weiterhin wird Fruktose, jedoch nur zu einem geringen Anteil von etwa 1-5 %, in der de-novo-Lipogenese zu freien Fettsäuren konvertiert [48]. Systematische Reviews und Meta-Analysen, die neben anderen Personengruppen auch Individuen mit T1Dm inkludierten, sowie eine randomisierte kontrollierte Studie mit T1Dm Patienten zeigen bei einem isokalorischen Vergleich von Fruktose mit anderen Kohlenhydraten niedrigere postprandiale Peaks für Blutglukose, niedrigere Gesamtcholesterin-Konzentrationen, keine Unterschiede in anderen Serumlipidparametern, jedoch möglicherweise erhöhte Harnsäurekonzentrationen und oxidativen Stress [49][50][51][52]. Aufgrund des hepatischen Stoffwechsels der Fruktose wird auch ihr Einfluss auf die hepatische Insulinsensitivität vielfach diskutiert.…”