Abstract
Resistant starch (RS) has been shown to beneficially affect insulin sensitivity in healthy individuals and those with metabolic syndrome, but its effects on human type 2 diabetes (T2DM) are unknown. This study aimed to determine the effects of increased RS consumption on insulin sensitivity and glucose control and changes in postprandial metabolites and body fat in T2DM. Seventeen individuals with well-controlled T2DM (HbA1c 46.6±2 mmol/mol) consumed, in a random order, either 40 g of type 2 RS (HAM-RS2) or a placebo, daily for 12 weeks with a 12-week washout period in between. At the end of each intervention period, participants attended for three metabolic investigations: a two-step euglycemic–hyperinsulinemic clamp combined with an infusion of [6,6-2H2] glucose, a meal tolerance test (MTT) with arterio-venous sampling across the forearm, and whole-body imaging. HAM-RS2 resulted in significantly lower postprandial glucose concentrations (P=0.045) and a trend for greater glucose uptake across the forearm muscle (P=0.077); however, there was no effect of HAM-RS2 on hepatic or peripheral insulin sensitivity, or on HbA1c. Fasting non-esterified fatty acid (NEFA) concentrations were significantly lower (P=0.004) and NEFA suppression was greater during the clamp with HAM-RS2 (P=0.001). Fasting triglyceride (TG) concentrations and soleus intramuscular TG concentrations were significantly higher following the consumption of HAM-RS2 (P=0.039 and P=0.027 respectively). Although fasting GLP1 concentrations were significantly lower following HAM-RS2 consumption (P=0.049), postprandial GLP1 excursions during the MTT were significantly greater (P=0.009). HAM-RS2 did not improve tissue insulin sensitivity in well-controlled T2DM, but demonstrated beneficial effects on meal handling, possibly due to higher postprandial GLP1.
Highlights
It is estimated that 25.8 million children and adults in the USA have diabetes (8.3% of the population), equating to a health cost of $218 billion (w10% of total healthcare expenditure)
Whole-body approach, stable isotope tracers to differentiate between changes in hepatic and peripheral insulin sensitivity of glucose uptake, body composition analysis using magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) to investigate changes in body fat depot distribution, and a meal tolerance test (MTT) combined with arterio-venous (A-V) sampling across muscle tissue, for the first time we investigated the efficacy of increasing
Consumption of HAM-RS2 has been extensively investigated in healthy groups and those with the metabolic syndrome (3, 4, 5, 6, 7, 10), this work represents the first attempt at translation of these findings into an efficacious dietary treatment for human T2DM
Summary
It is estimated that 25.8 million children and adults in the USA have diabetes (8.3% of the population), equating to a health cost of $218 billion (w10% of total healthcare expenditure). The USDA-recommended fiber intake is 14 g/1000 kcal in healthy individuals, with evidence currently lacking to recommend a higher intake in people with diabetes This was highlighted in a scientific advisory committee (SACN) statement on nutrition that stated, cereal fiber intake has been associated with a reduced incidence of type 2 diabetes (T2DM) and metabolic risk factors such as insulin resistance, the majority of evidence relates to T2DM prevention. While this is important given the current obesity epidemic, it cannot necessarily be translated into health benefits for those patients with T2DM (2)
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