- Title
- Both dietary protein and fat increase postprandial glucose excursions in children with type 1 diabetes, and the effect is additive
- Creator
- Smart, Carmel E. M.; Evans, Megan; O'Connell, Susan M.; McElduff, Patrick; Lopez, Prudence E.; Jones, Timothy W.; Davis, Elizabeth A.; King, Bruce R.
- Relation
- Diabetes Care Vol. 36, Issue 12, p. 3897-3902
- Publisher Link
- http://dx.doi.org/10.2337/dc13-1195
- Publisher
- American Diabetes Association
- Resource Type
- journal article
- Date
- 2013
- Description
- Objective: To determine the separate and combined effects of high-protein (HP) and high-fat (HF) meals, with the same carbohydrate content, on postprandial glycemia in children using intensive insulin therapy (IIT). Research Design and Methods: Thirty-three subjects aged 8–17 years were given 4 test breakfasts with the same carbohydrate amount but varying protein and fat quantities: low fat (LF)/low protein (LP), LF/HP, HF/LP, and HF/HP. LF and HF meals contained 4 g and 35 g fat. LP and HP meals contained 5 g and 40 g protein. An individually standardized insulin dose was given for each meal. Postprandial glycemia was assessed by 5-h continuous glucose monitoring. Results: Compared with the LF/LP meal, mean glucose excursions were greater from 180 min after the LF/HP meal (2.4 mmol/L [95% CI 1.1–3.7] vs. 0.5 mmol/L [−0.8 to 1.8]; P = 0.02) and from 210 min after the HF/LP meal (1.8 mmol/L [0.3–3.2] vs. −0.5 mmol/L [−1.9 to 0.8]; P = 0.01). The HF/HP meal resulted in higher glucose excursions from 180 min to 300 min (P < 0.04) compared with all other meals. There was a reduction in the risk of hypoglycemia after the HP meals (odds ratio 0.16 [95% CI 0.06–0.41]; P < 0.001). Conclusions: Meals high in protein or fat increase glucose excursions in youth using IIT from 3 h to 5 h postmeal. Protein and fat have an additive impact on the delayed postprandial glycemic rise. Protein had a protective effect on the development of hypoglycemia. Current management of people with type 1 diabetes (T1D) on intensive insulin therapy (IIT) advocates algorithms based on the carbohydrate content of the meal to calculate the prandial insulin dose (1,2). This approach is recommended as a means to improve glycemic control and allow greater dietary flexibility (3,4). Typically, these calculations do not take into account the protein and fat content of the meal. In recent years, novel algorithms have recommended counting fat and protein units, in addition to carbohydrate, in order to determine a supplementary insulin requirement for high-fat and -protein meals (5). However, increased postprandial hypoglycemia has been observed in children following these recommendations (6). A recent study (7) showed that meals high in fat do require more insulin than lower-fat meals with the same carbohydrate content, supporting the need for alternative insulin dosing algorithms for high-fat (HF) meals. However, there is a general paucity of evidence regarding the impact of protein and fat on postprandial glycemia in patients utilizing IIT, and consistent clinical advice for optimal management of high-protein (HP) and HF meals is lacking. To date, protein has been considered together with fat in test meal studies, and controlled trials examining the effect of variations in protein content, independent of other macronutrients, on postprandial glucose levels have not been performed in individuals with T1D using insulin pump or multiple daily injection therapies. Therefore, this study was undertaken to examine the separate and combined effects of HP and HF meals, all with the same carbohydrate content, on postprandial glycemia in children and adolescents using IIT.
- Subject
- diabetes; high protein diet; fat increase; high fat diet; postprandial glycemia; intensive insulin therapy
- Identifier
- http://hdl.handle.net/1959.13/1318803
- Identifier
- uon:23691
- Identifier
- ISSN:0149-5992
- Language
- eng
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