Abstract
Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (−0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (−0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.
Highlights
Pregnant women develop decreased insulin sensitivity with increasing gestational age.The adapted insulin sensitivity in the mother ensures sufficient nutrients supply for the growing fetus [1]
The aim of the present study was to investigate the effects of a High-carbohydrate-morning-intake (HCM) compared to a low-carbohydrate-morning-intake (LCM), both diets isocaloric for each participant and with the same total carbohydrate content, on glycemic variability in Gestational diabetes mellitus (GDM) patients measured by mean amplitude of glucose excursions (MAGE) and coefficient of variation (CV), using continuous glucose measurements (CGM)
This study showed that a high-carbohydrate morning-intake (HCM) diet gave a higher MAGE and CV%, indicating a higher glycemic variability, when comparing with a LCM diet
Summary
Pregnant women develop decreased insulin sensitivity with increasing gestational age.The adapted insulin sensitivity in the mother ensures sufficient nutrients supply for the growing fetus [1]. Pregnant women develop decreased insulin sensitivity with increasing gestational age. In women with Gestational diabetes mellitus (GDM) insulin sensitivity is reduced even further and GDM is defined as decreased glucose tolerance developed during pregnancy [2,3]. With repeated episodes of hyperglycemia, the fetus receives too much glucose [4,6] and several studies on GDM patients have shown a correlation between increasing blood glucose levels and birth complications [7,8,9]. According to studies including pregnant women with type 1 diabetes and type 2 diabetes, large variations in blood glucose levels cause more complications than constantly elevated blood glucose levels [10,11]. Twenty-four hours continuous glucose measurements (CGM) detect a more detailed glycemic profile than self-monitored blood glucose (SMGB) by better measuring the duration and magnitude of fluctuation, especially for fasting and postprandial measurements [12,13]
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