Abstract
Aims/hypothesisThe aim of this work was to assess the relationship between meal nutrients and postprandial blood glucose response (PGR) in individuals with type 1 diabetes on a hybrid closed-loop system (HCLS).MethodsThe dietary composition of 1264 meals (398 breakfasts, 441 lunches and 425 dinners) was assessed by 7-day food records completed by 25 individuals with type 1 diabetes on HCLSs (12 men/13 women, mean ± SD age 40 ± 12 years, mean ± SD HbA1c 51 ± 10 mmol/mol [6.9 ± 0.2%]). For each meal, PGR (continuous glucose monitoring metrics, glucose incremental AUCs) and insulin doses (pre-meal boluses, post-meal microboluses automatically delivered by the pump and adjustment boluses) over 6 h were evaluated.ResultsBreakfast, lunch and dinner significantly differed with respect to energy and nutrient intake and insulin doses. The blood glucose postprandial profile showed an earlier peak after breakfast and a slow increase until 4 h after lunch and dinner (p < 0.001). Mean ± SD postprandial time in range (TIR) was better at breakfast (79.3 ± 22.2%) than at lunch (71.3 ± 23.9%) or dinner (70.0 ± 25.9%) (p < 0.001). Significant negative predictors of TIR at breakfast were total energy intake, per cent intake of total protein and monounsaturated fatty acids, glycaemic load and absolute amounts of cholesterol, carbohydrates and simple sugars consumed (p < 0.05 for all). No significant predictors were detected for TIR at lunch. For TIR at dinner, a significant positive predictor was the per cent intake of plant proteins, while negative predictors were glycaemic load and intake amounts of simple sugars and carbohydrate (p < 0.05 for all).Conclusions/interpretationThis study shows that nutritional factors other than the amount of carbohydrate significantly influence postprandial blood glucose control. These nutritional determinants vary between breakfast, lunch and dinner, with differing effects on postprandial blood glucose profile and insulin requirements, thus remaining a challenge to HCLSs.Graphical abstract
Highlights
Optimal blood glucose control is challenging in individuals with type 1 diabetes, in the postprandial period [1, 2].Carbohydrates (CHOs) are the main determinants of postprandial glucose response (PGR) [1]
Breakfast, lunch and dinner significantly differed with respect to energy and nutrient intake and insulin doses
The blood glucose postprandial profile showed an earlier peak after breakfast and a slow increase until 4 h after lunch and dinner
Summary
Optimal blood glucose control is challenging in individuals with type 1 diabetes, in the postprandial period [1, 2]. Carbohydrates (CHOs) are the main determinants of postprandial glucose response (PGR) [1]. Mounting evidence is available on the effects of other dietary components on PGR (i.e. protein and fat). High intake of dietary protein may increase. A further mechanism for increasing blood glucose levels may relate to glucagon stimulation by protein and fat [9, 10]. This raises concerns on the effectiveness of solely using CHO counting for estimating prandial insulin [11]
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