The Use of Low Glycaemic Index Foods Improves Metabolic Control of Diabetic Patients over Five Weeks

Abstract

The aim of the present study was to determine whether any benefit might occur from lowering the glycaemic index of diet in the medium term in diabetic patients. Eighteen well-controlled diabetic patients (12 Type 1 and 6 Type 2 non-insulin-treated), were assigned to either a high mean glycaemic index or low mean glycaemic index diet for 5 weeks each in a random order using a cross-over design. The two diets were equivalent in terms of nutrient content and total and soluble fibre content. The glycaemic indices were 64 +/- 2 (mean +/- SD) % and 38 +/- 5% for the two diets. The high glycaemic index diet was enriched in bread and potato and the low glycaemic index diet in pasta, rice, and legumes. At the end of the study periods, the following variables were improved on the low compared to the high glycaemic index diet: fructosamine (3.9 +/- 0.9 vs 3.4 +/- 0.4 mmol l-1, p less than 0.05); fasting blood glucose (10.8 +/- 2.8 vs 9.6 +/- 2.7 mmol l-1, p less than 0.02); 2-h postprandial blood glucose (11.6 +/- 2.9 vs 10.3 +/- 2.5 mmol l-1, p less than 0.02); mean daily blood glucose (12.0 +/- 2.5 vs 10.4 +/- 2.7 mmol l-1, p less than 0.02); serum triglycerides (1.5 +/- 0.9 vs 1.2 +/- 0.6 mmol l-1, p less than 0.05). No significant differences were found in body weight, HbA1C, insulin binding to erythrocytes, insulin and drug requirements, and other circulating lipids (cholesterol, HDL-cholesterol, phospholipids, Apolipoprotein A1, Apolipoprotein B). Thus the inclusion of low glycaemic index foods in the diet of diabetic patients may be an additional measure which slightly but favourably influences carbohydrate and lipid metabolism, requires only small changes in nutritional habits and has no known deleterious effects.

Recommendations for the nutritional management of patients with diabetes mellitus

“…The use of low GI staple foods to form the basic and major component of each meal offers bene®ts with lipid reduction (Wolever et al, 1992) and improvements in glycaemic control (Frost et al, 1994;Fontvieille et al, 1992;Brand et al, 1991). The GI of a food is affected by the rate of digestion and absorption of the carbohydrate present in the food (Hermansen, 1994).…”

Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes

“…Of these reports, 226 were excluded based on other criteria, leaving 41 trials (39 reports) that satisfied the inclusion criteria but did not meet the exclusion criteria, of which 11 trials (ten reports) investigated pulses alone, 19 trials (19 reports) investigated pulses in a low-GI dietary intervention, and 11 trials (ten reports) investigated pulses in a high-fibre dietary intervention. Tables 1, 2, and 3 show the characteristics of the 41 randomised controlled experimental trials included in each of the three meta-analyses: pulses alone [45][46][47][48][49][50][51][52][53][54], pulses in low-GI diets [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and pulses in highfibre diets [55][56][57][58][59][60][61][62][63][64]. The 11 trials (ten reports) investigating pulses alone (Table 1) were predominantly crossover in design (seven trials, five of which had a washout period), studied a total of 253 participants (type 2 diabetes, n=21; normoglycaemia and/or hypercholesterolaemia, n=232) and had a mean sample size of 23.…”

“…In early studies, pulses were shown to result in exceptionally low glycaemic responses when fed to healthy volunteers [11], and in later experiments were demonstrated to possess a carbohydrate component that was more slowly digested than that of other foods such as cereals [12]. This property of slower absorption, which is common to α-glucosidase inhibitors, makes pulses an important means of lowering the GI of the diet, a characteristic that has been exploited extensively in studies of low-GI diets [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], and would therefore be predicted to benefit glycaemic control and, by analogy with acarbose, CHD risk [8]. Based on limited clinical experimental evidence, the European (EASD) [32], Canadian (CDA) [33], and American (ADA) [34] diabetes associations recommend the consumption of dietary pulses as a means of optimising diabetes control through lowering the GI and increasing the dietary fibre content of the diet.…”

Effects of meal frequency and high-fibre rye-bread diet on glucose and lipid metabolism and ileal excretion of energy and sterols in ileostomy subjects

“…Carbohydrate food, which is more slowly digested, results in reduced glucose and insulin responses (O'Dea et al, 1981;Jenkins et al, 1982). Slowly digested starchy foods appear to be either lipid neutral or to reduce concentrations of triglycerides and low-density lipoprotein (LDL) cholesterol without significant reductions or even increased concentration of high-density lipoprotein (HDL) cholesterol (Jenkins et al, 1987b, c;Fontvieille et al, 1988Fontvieille et al, , 1992Wolever et al, 1992a, b;Miller, 1994). Dietary fibre can also alter postprandial lipid and cholesterol responses (Cara et al, 1992;Anderson et al, 1995;Dubois et al, 1995).…”

“…In medium-to long-term studies (from 2 to 12 weeks), reviewed by Miller (1994) and a study by Fontvieille et al (1992), low glycemic-index diets appear to reduce urinary C-peptide excretion in diabetic subjects and normal volunteers and lower concentrations of fructosamine and/or glycosylated haemoglobin (HbA 1C ). A corresponding beneficial effect of high-fibre diets (HFDs) has been observed for prevention of diabetes or in non-insulin dependent diabetes mellitus patients (Rivellese et al, 1980;Simpson et al, 1981;Anderson et al, 1987;Salmeron et al, 1997) and animals (Berglund et al, 1982).…”