Effect of a low dose whey/guar preload on glycemic control in people with type 2 diabetes-a randomised controlled trial

Nutrition Journal

Leah Coles²  Claire Galbraith²  Peter M Clifton¹ 

[1] University of South Australia, North Terrace, GPO Box 2471, Adelaide, SA 5001, Australia;Baker IDI Heart and Diabetes Institute, Prahan, VIC, Australia

关键词: Type 2 diabetes;    Glycemic control;    Guar;    Whey;   

Others  :  1132457
DOI  :  10.1186/1475-2891-13-103

 received in 2014-08-04, accepted in 2014-10-15,  发布年份 2014

【 摘 要 】

Objective

Large preloads of protein and fat have been shown to lower glucose after a carbohydrate-rich meal in people with type 2 diabetes but add a considerable energy burden. Low calorie preloads [<5% of daily energy intake] have been tested in this study in people with prediabetes and with type 2 diabetes.

Research design and methods

This was an unblinded randomised crossover study with two placebo days and two active treatment days. Glucose was measured for 3 hours with fingerprick samples as well as continuous glucose monitoring [CGMS]. Twenty-four subjects with pre-diabetes or moderately controlled type 2 diabetes [fasting glucose < 10 and HbA1c < 8.5%] were recruited. The preload contained 17 g whey protein plus 3 g lactose and 5 g guar, and 1 g flavour material [including sucralose] dissolved in 150 ml cold water or 150 ml cold water with no additives. The breakfast test meal consisted of 2 slices of bread, margarine and jam [3 slices for men] with the test drink 15 minutes beforehand.

Results

Peak fingerprick glucose was reduced by 2.1 mmol/L at 45 min [p < 0.0001]. Average fingerprick glucose over 3 hours was reduced by 0.8 mmol/L [p = 0.0003]. There was no difference between those with diabetes or prediabetes or those on medication or not on medication.

Conclusions

An 80 kcal whey protein/fibre preload can lower average glucose over 3 hours by 0.8 mmol/L. If used long term before at least two carbohydrate-rich meals/day this preload could lower HbA1c by up to 1%.

Trial registration

The trial was registered with the Australian New Zealand Clinical Trials Registry number ACTRN12612001251819.

【 授权许可】

   
2014 Clifton et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS Jr: American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013, 11:3821-3842.
• [2]Thomas D, Elliott EJ: Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev 2009, 1:CD006296.
• [3]Brekke HK, Sunesson A, Axelsen M, Lenner RA: Attitudes and barriers to dietary advice aimed at reducing risk of type 2 diabetes in first-degree relatives of patients with type 2 diabetes. J Hum Nutr Dietet 2004, 17:513-521.
• [4]Ma J, Stevens JE, Cukier K, Maddox AF, Wishart JM, Jones KL, Clifton PM, Horowitz M, Rayner CK: Effects of a protein preload on gastric emptying, glycemia, and gut hormones after a carbohydrate meal in diet-controlled type 2 diabetes. Diabetes Care 2009, 32:1600-1602.
• [5]Samocha-Bonet D, Wong O, Synnott EL, Piyaratna N, Douglas A, Gribble FM, Holst JJ, Chisholm DJ, Greenfield JR: Glutamine reduces postprandial glycemia and augments the glucagon-like peptide-1 response in type 2 diabetes patients. J Nutr 2011, 141:1233-1238.
• [6]Wanders AJ, Feskens EJ, Jonathan MC, Schols HA, de Graaf C, Mars M: Pectin is not pectin: A randomized trial on the effect of different physicochemical properties of dietary fiber on appetite and energy intake. Physiol Behav 2014, 128:212-219.
• [7]Russo A, Stevens JE, Wilson T, Wells F, Tonkin A, Horowitz M, Jones KL: Guar attenuates fall in postprandial blood pressure and slows gastric emptying of oral glucose in type 2 diabetes. Dig Dis Sci 2003, 48:1221-1229.
• [8]Gentilcore D, Chaikomin R, Jones KL, Russo A, Feinle-Bisset C, Wishart JM, Rayner CK, Horowitz M: Effects of fat on gastric emptying of and the glycemic, insulin, and incretin responses to a carbohydrate meal in type 2 diabetes. J Clin Endocrinol Metab 2006, 91:2062-2067.
• [9]Tagliaferro V, Cassader M, Bozzo C, Pisu E, Bruno A, Marena S, Cavallo-Perin P, Cravero L, Pagano G: Moderate guar-gum addition to usual diet improves peripheral sensitivity to insulin and lipaemic profile in NIDDM. Diabetes Metab 1985, 11:380-385.
• [10]Wu T, Bound MJ, Zhao BR, Standfield SD, Bellon M, Jones KL, Horowitz M, Rayner CK: Effects of a D-xylose preload with or without sitagliptin on gastric emptying, glucagon-like peptide-1, and postprandial glycemia in type 2 diabetes. Diabetes Care 2013, 36:1913-1918.
• [11]Guerci B, Monnier L, Serusclat P, Petit C, Valensi P, Huet D, Raccah D, Colette C, Quéré S, Dejager S: Continuous glucose profiles with vildagliptin versus sitagliptin in add-on to metformin: results from the randomized Optima study. Diabetes Metab 2012, 38:359-366.
• [12]Zhan M, Xu T, Wu F, Tang Y: Sitagliptin in the treatment of type 2 diabetes: a meta-analysis. J Evid Based Med 2012, 5:154-165.
• [13]Esposito K, Maiorino MI, Di Palo C, Giugliano D, Campanian Post-Prandial Hyperglycemia Study Group: Dietary glycemic index and glycemic load are associated with metabolic control in type 2 diabetes: The CAPRI experience. Metab Syndr Relat Disord 2010, 8:255-261.
• [14]Jenkins DJ, Kendall CW, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL, Vidgen E, Josse AR, Nguyen TH, Corrigan S, Banach MS, Ares S, Mitchell S, Emam A, Augustin LS, Parker TL, Leiter LA: Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008, 300:2742-2753.
• [15]Opperman AM, Venter CS, Oosthuizen W, Thompson RL, Vorster HH: Meta-analysis of the health effects of using the glycaemic index in meal-planning. Br J Nutr 2004, 92:367-381.
• [16]Akhavan T, Luhovyy BL, Brown PH, Cho CE, Anderson GH: Effect of premeal consumption of whey protein and its hydrolysate on food intake and postmeal glycemia and insulin responses in young adults. Am J Clin Nutr 2010, 91:966-975.
• [17]Gunnerud UJ, Heinzle C, Holst JJ, Östman EM, Björck IM: Effects of pre-meal drinks with protein and amino acids on glycemic and metabolic responses at a subsequent composite meal. PLoS One 2012, 7(9):e44731.
• [18]Akhavan T, Luhovyy BL, Panahi S, Kubant R, Brown PH, Anderson GH: Mechanism of action of pre-meal consumption of whey protein on glycemic control in young adults. J Nutr Biochem 2014, 25:36-43.
• [19]Hanefeld M, Fischer S, Julius U, Schulze J, Schwanebeck U, Schmechel H, Ziegelasch HJ, Lindner J: Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 1996, 39:1577-1583.
• [20]Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M: Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab 2006, 91:813-819.
• [21]Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D: Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 2004, 25:10-16.