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Effects of carbohydrate restriction on postprandial glucose metabolism, β-cell function, gut hormone secretion, and satiety in patients with Type 2 diabetes.

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Dietary carbohydrate restriction may improve the phenotype of Type 2 diabetes (T2D) patients. We aimed to investigate 6 wk of carbohydrate restriction on postprandial glucose metabolism, pancreatic α- and β-cell function, gut hormone secretion, and satiety in T2D patients. Methods In a crossover design, 28 T2D patients (mean HbA 1c: 60 mmol/mol) were randomized to 6 wk of carbohydrate-reduced high-protein (CRHP) diet and 6 wk of conventional diabetes (CD) diet (energy-percentage carbohydrate/protein/fat: 30/30/40 vs. 50/17/33). Twenty-four-hour continuous glucose monitoring (CGM) and mixed-meal tests were undertaken and fasting intact proinsulin (IP), 32,33 split proinsulin concentrations (SP), and postprandial insulin secretion rates (ISR), insulinogenic index (IGI), β-cell sensitivity to glucose ( B up), glucagon, and gut hormones were measured. Gastric emptying was evaluated by postprandial paracetamol concentrations and satiety by visual analog scale ratings. A CRHP diet reduced postprandial glucose area under curve (net AUC) by 60% ( P < 0.001), 24 h glucose by 13% ( P < 0.001), fasting IP and SP concentrations (both absolute and relative to C-peptide, P < 0.05), and postprandial ISR (24%, P = 0.015), while IGI and B up improved by 31% and 45% (both P < 0.001). The CRHP diet increased postprandial glucagon net AUC by 235% ( P < 0.001), subjective satiety by 18% ( P = 0.03), delayed gastric emptying by 15 min ( P < 0.001), decreased gastric inhibitory polypeptide net AUC by 29% ( P < 0.001), but had no significant effect on glucagon-like-peptide-1, total peptide YY, and cholecystokinin responses. A CRHP diet reduced glucose excursions and improved β-cell function, including proinsulin processing, and increased subjective satiety in patients with T2D.

Original languageEnglish
JournalAmerican Journal of Physiology: Endocrinology and Metabolism
Volume320
Issue number1
Pages (from-to)E7-E18
ISSN0193-1849
DOIs
Publication statusPublished - 1 Jan 2021

Bibliographical note

Publisher Copyright:
© 2021 the American Physiological Society

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

    Research areas

  • Appetite regulatory hormones, B -cell function, Incretin hormones, Nutritional therapy, Type 2 diabetes mellitus, Proinsulin/blood, Satiety Response, Blood Glucose/metabolism, Humans, Insulin-Secreting Cells/metabolism, Male, Treatment Outcome, Diet, Carbohydrate-Restricted/adverse effects, Hyperglycemia/metabolism, Gastric Emptying, Gastrointestinal Hormones/metabolism, Diabetes Mellitus, Type 2/diet therapy, Dietary Proteins, Adult, Female, Glucose/metabolism, Insulin Secretion

ID: 61112463