Abstract
Postprandial glycemic control is an important target for optimal type 2 diabetes management, but is often difficult to achieve. The gastrointestinal tract plays a major role in modulating postprandial glycaemia in both health and diabetes. The various strategies that have been proposed to modulate gastrointestinal function, particularly by slowing gastric emptying and/or stimulating incretin hormone GLP-1, are summarized in this review.
Highlights
The importance of glycemic control to the optimal management of diabetes has been clearly established [1]
Glycemic control can be estimated in a number of ways – including random blood glucose, fasting glucose, postprandial glucose, oral glucose tolerance test or OGTT [which incorporates both fasting glucose and the glycemic response to an oral glucose load] and glycated hemoglobin or HbA1c
In 2001, the ADA published a consensus statement relating to PPG and subsequently, in 2014, the International Diabetes Federation (IDF) released specific strategies for the management of PPG excursions in type 1 and type 2 diabetes advocating the use of dietary strategies and use of anti-diabetic medications which target postprandial glycaemia [2, 6]
Summary
The importance of glycemic control to the optimal management of diabetes has been clearly established [1]. Slowing of gastric emptying is a major mechanism to account for postprandial glucose lowering by exogenous GLP-1, as postprandial plasma insulin levels are usually reduced, rather than greater [34] These observations stimulated the development and subsequent widespread use of ‘GLP-1 based’ drugs for use in the management of type 2 diabetes. A longer-term intervention study reported a significant lowering of postprandial blood glucose (~14%) and HbA1c (0.3%), where participants with type 2 diabetes consumed Inzone Preload (consisting only of natural food ingredients including pea-protein, whey protein, egg albumin, W 3/6 fatty acids, whole eggs, apple, rosehip, and sugar beet fiber) (29% protein) 30 min before each of three meals daily for 12 weeks [80]. Gannon et al reported that increasing the ratio of protein and fat, while decreasing ratio of carbohydrate, leads to a 38% reduction in net mean 24-h integrated glucose area response (including PPG) [50, 81]
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