Equivalent Glycemic Load (EGL) of Atkins Chocolate Peanut Butter Bar and Atkins Chocolate Ready-to-Drink Shake in People With Type 2 Diabetes

Abstract

ObjectivesIt is difficult to estimate the glycemic impact of low-carbohydrate (low-CHO) foods from the information in the Nutrition Facts Table. We developed equivalent glycemic load (EGL) to quantify the glycemic impact of low-CHO foods in people without diabetes. The current objective was to determine the feasibility and safety of measuring EGL in people with type 2 diabetes (T2D). MethodsOvernight fasted adults with T2D treated by diet or oral agents and A1c < 8.1% consumed 1 serving of Atkins Chocolate Peanut Butter Bar (CPB) or Atkins Milk Chocolate Shake (MCS) or 45 g white bread (WB) in random order on 3 separate days. CPB/MCS, respectively, contained 150/160 kcal, 14/9 g fat, 16/15 g protein, 23/5 g CHO and 12/3 g fiber. We took finger-stick blood fasting and every 30 min for 3 h after starting to eat. Serum glucose was measured by glucometer (analytic CV = 8.6%) and by the Vitros Chemistry System (Vitros, CV = 1.6%). In each subject F/(WB/Cwb) was calculated where F = incremental area under the curve (iAUC) for the food, WB = iAUC after WB and Cwb = 20.8 (the amount of CHO in WB). EGL = mean F/(WB/Cwb), after excluding values >2 SD from the mean. ResultsWe screened 18 subjects; 4 were ineligible (A1c >8.0%), 14 were enrolled and 2 dropped out. The remaining 12 subjects (5 males, 7 females; aged 43–75 (mean ± SD, 63 ± 11) yr; BMI 23.0–56.0 (35.2 ± 9.0) kg/m2) completed in the study. By Vitros, the EGLs (mean [95% confidence interval] for CPB, 4.1 [2.0, 6.2] g (n = 11), and MCD, 3.8 [1.6, 6.0] g (n = 11) were similar to those by glucometer CPB, 5.8 [2.5, 9.1] g (n = 12) and MCD, 3.0 [0.8, 5.2] g (n = 11). There were no episodes of hypoglycemia during the study. Loose stools were experienced by 1 subject after CPB and by a different subject after MCS, events considered to be possibly related to the study products. ConclusionsThe results suggest it is feasible and safe to measure EGL in people with T2D not taking insulin. Funding SourcesSimply Good Foods USA, Inc.