Does dietary fat cause a dose dependent glycemic response in youth with type 1 diabetes?

Abstract

To determine the glycemic impact of dietary fat alone consumed without prandial insulin in individuals with T1D. Thirty participants with T1D (aged 8-18 years) consumed a test drink with either 20 g glucose or 1, 13, 26, 39, 51 g of fat with negligible carbohydrate/protein on 6 consecutive evenings, in a randomized order without insulin. Continuous glucose monitoring was used to measure glucose levels for 8h postprandially. Primary outcome was mean glycemic excursion at each 30min interval for each test condition. Generalized linear mixed models with a random effect for people with diabetes were used to test for an increase in blood glucose excursion with increasing quantity of fat. Glycemic excursions after 20 g glucose were higher than after fat drinks over the first 2 h (p< 0.05). Glycemic excursion for the fat drinks demonstrated a dose response, statistically significant from 4 h (p=0.026), such that increasing loads of fat caused a proportionally larger increase in glycemic excursion, remaining statistically significant until 8 h (p < 0.05). Overall, for every 10g fat added to the drink, glucose concentrations rose by a mean of 0.28 mmol L-1 from 330 min (95% CI 0.15 to 0.39, p < 0.001). Fat ingested without other macronutrients increases glucose excursions from 4 to 8 h after ingestion, in a dose dependent manner. These observations may impact on insulin dosing for high-fat foods in individuals with T1D.