Abstract

A reduction in carbohydrate intake and low-carbohydrate diets are often advocated to prevent and manage diabetes. However, limiting or eliminating carbohydrates may not be a long-term sustainable and maintainable approach for everyone. Alternatively, diet strategies to modulate glycemia can focus on the glycemic index (GI) of foods and glycemic load (GL) of meals. To assess the effect of a reduction in glycemic load of a 24 h diet by incorporating innovative functional ingredients (β-glucan, isomaltulose) and alternative low GI Asian staples (noodles, rice)on glycemic control and variability, twelve Chinese men (Age: 27.0 ± 5.1 years; BMI:21.6 ± 1.8kg/m2) followed two isocaloric, typically Asian, 24h diets with either a reduced glycemic load (LGL) or high glycemic load (HGL) in a randomized, single-blind, controlled, cross-over design. Test meals included breakfast, lunch, snack and dinner and the daily GL was reduced by 37% in the LGL diet. Continuous glucose monitoring provided 24 h glycemic excursion and variability parameters: incremental area under the curve (iAUC), max glucose concentration (Max), max glucose range, glucose standard deviation (SD), and mean amplitude of glycemic excursion (MAGE), time in range (TIR). Over 24h, the LGL diet resulted in a decrease in glucose Max (8.12 vs. 6.90 mmol/L; p = 0.0024), glucose range (3.78 vs. 2.21 mmol/L; p = 0.0005), glucose SD (0.78 vs. 0.43 mmol/L; p = 0.0002), mean amplitude of glycemic excursion (2.109 vs. 1.008; p < 0.0001), and increase in 4.5–6.5mmol/L TIR (82.2 vs. 94.6%; p = 0.009), compared to the HGL diet. The glucose iAUC, MAX, range and SD improved during the 2 h post-prandial window of each LGL meal, and this effect was more pronounced later in the day. The current results validate the dietary strategy of incorporating innovative functional ingredients (β-glucan, isomaltulose) and replacing Asian staples with alternative low GI carbohydrate sources to reduce daily glycemic load to improve glycemic control and variability as a viable alternative to the reduction in carbohydrate intake alone. These observations provide substantial public health support to encourage the consumption of staples of low GI/GL to reduce glucose levels and glycemic variability. Furthermore, there is growing evidence that the role of chrononutrition, as reported in this paper, requires further examination and should be considered as an important addition to the understanding of glucose homeostasis variation throughout the day.

Highlights

  • The prevalence of type 2 diabetes and related risk factors have increased dramatically across Asia in recent decades and Singapore is no exception

  • Our results showed that the inclusion of isomaltulose as part of a 24 h LGL diet can aide in the decrease of 24 h glycemic variability and can help to decrease the glycemic response, peak and range after a meal

  • Studies have demonstrated that oat and barley products which are natural sources of β-glucan and starchy products fortified with β-glucan aid in reducing glycemic response without an increase in insulin secretion to mediate increased glucose clearance [41]

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Summary

Introduction

The prevalence of type 2 diabetes and related risk factors have increased dramatically across Asia in recent decades and Singapore is no exception. The Asian phenotype, marked by relatively greater body fat within the normal body weight and BMI range, has been shown to be more susceptible to diabetes than the Caucasian phenotype [2]. Diabetes is often diagnosed at a lower body mass index (BMI) and a younger age and the transition from prediabetes to diabetes is more dramatic in Asians [3]. Chronic high blood glucose levels are considered a major risk factor for the onset of diabetes; in addition, greater glucose variability has independently been linked to the increased risk for the development of diabetes and cardiovascular diseases (CVD) [4,5,6], likely via a combination of increased inflammation, oxidative stress and endothelial dysfunction [7,8,9,10]. Fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) are easy–to-perform standard reference measurements used in a clinical setting as an indication of glycemic control and for diabetes diagnosis [6]

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