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

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  • Mads J. Skytte, Bispebjerg Hospital
  • ,
  • Amirsalar Samkani, Bispebjerg Hospital
  • ,
  • Arne Astrup, University of Copenhagen
  • ,
  • Jan Frystyk
  • Jens F. Rehfeld, Rigshospitalet
  • ,
  • Jens J. Holst, University of Copenhagen
  • ,
  • Sten Madsbad, University of Copenhagen
  • ,
  • Keith Burling, Cambridge University Hospitals NHS Foundation Trust
  • ,
  • Mogens Fenger, Hvidovre Hospital
  • ,
  • Mads N. Thomsen, Bispebjerg Hospital
  • ,
  • Thomas M. Larsen, University of Copenhagen
  • ,
  • Thure Krarup, Bispebjerg Hospital
  • ,
  • Steen B. Haugaard, Bispebjerg Hospital

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 a- and b-cell function, gut hormone secretion, and satiety in T2D patients. Methods In a crossover design, 28 T2D patients (mean HbA1c: 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), b-cell sensitivity to glucose (Bup), 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 Bup 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 b-cell function, including proinsulin processing, and increased subjective satiety in patients with T2D.

Original languageEnglish
JournalAmerican Journal of Physiology - Endocrinology and Metabolism
Volume320
Issue1
Pages (from-to)E7-E18
Number of pages12
ISSN0193-1849
DOIs
Publication statusPublished - Jan 2021

    Research areas

  • Appetite regulatory hormones, B -cell function, Incretin hormones, Nutritional therapy, Type 2 diabetes mellitus

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