A carbohydrate-reduced high-protein diet acutely decreases postprandial and diurnal glucose excursions in type 2 diabetes patients

Br J Nutr. 2018 Apr;119(8):910-917. doi: 10.1017/S0007114518000521.

Abstract

The aim of the study was to assess whether a simple substitution of carbohydrate in the conventionally recommended diet with protein and fat would result in a clinically meaningful reduction in postprandial hyperglycaemia in subjects with type 2 diabetes mellitus (T2DM). In all, sixteen subjects with T2DM treated with metformin only, fourteen male, with a median age of 65 (43-70) years, HbA1c of 6·5 % (47 mmol/l) (5·5-8·3 % (37-67 mmol/l)) and a BMI of 30 (sd 4·4) kg/m2 participated in the randomised, cross-over study. A carbohydrate-reduced high-protein (CRHP) diet was compared with an iso-energetic conventional diabetes (CD) diet. Macronutrient contents of the CRHP/CD diets consisted of 31/54 % energy from carbohydrate, 29/16 % energy from protein and 40/30 % energy from fat, respectively. Each diet was consumed on 2 consecutive days in a randomised order. Postprandial glycaemia, pancreatic and gut hormones, as well as satiety, were evaluated at breakfast and lunch. Compared with the CD diet, the CRHP diet reduced postprandial AUC of glucose by 14 %, insulin by 22 % and glucose-dependent insulinotropic polypeptide by 17 % (all P<0·001), respectively. Correspondingly, glucagon AUC increased by 33 % (P<0·001), cholecystokinin by 24 % (P=0·004) and satiety scores by 7 % (P=0·035), respectively. A moderate reduction in carbohydrate with an increase in fat and protein in the diet, compared with an energy-matched CD diet, greatly reduced postprandial glucose excursions and resulted in increased satiety in patients with well-controlled T2DM.

Trial registration: ClinicalTrials.gov NCT02472951.

Keywords: β-GS β-cell glucose sensitivity; CCK cholecystokinin; CD conventional diabetes; CRHP carbohydrate-reduced high protein; CSS composite satiety score; GIP glucose-dependent insulinotropic polypeptide; GLP-1 glucagon-like peptide-1; ISR insulin secretion rate; PYY peptide YY; T2DM type 2 diabetes mellitus; TEE total energy expenditure; VAS visual analogue scale; Carbohydrates; Diabetes; Postprandial glucose.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / drug effects*
  • C-Peptide / blood
  • Cross-Over Studies
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Dietary Carbohydrates / administration & dosage*
  • Dietary Carbohydrates / pharmacology
  • Dietary Proteins / administration & dosage*
  • Dietary Proteins / pharmacology
  • Female
  • Glycated Hemoglobin A
  • Humans
  • Insulin / blood
  • Male
  • Middle Aged

Substances

  • Blood Glucose
  • C-Peptide
  • Dietary Carbohydrates
  • Dietary Proteins
  • Glycated Hemoglobin A
  • Insulin

Associated data

  • ClinicalTrials.gov/NCT02472951