Absorption patterns of meals containing complex carbohydrates in type 1 diabetes

作者：Elleri D; Allen J M; Harris J; Kumareswaran K; Nodale M; Leelarathna L; Acerini C L; Haidar A; Wilinska M E; Jackson N; Umpleby A M; Evans M L; Dunger D B; Hovorka R^*

来源：Diabetologia, 2013, 56(5): 1108-1117.

DOI：10.1007/s00125-013-2852-x

• Glucose absorption
• Glucose models
• Glycaemic load
• Stable-label tracer
• Tracer methodology
• Type 1 diabetes

Aims/hypothesis Successful postprandial glycaemia management requires understanding of absorption patterns after meals containing variable complex carbohydrates. We studied eight young participants with type 1 diabetes to investigate a large low-glycaemic-load (LG) meal and another eight participants to investigate a high-glycaemic-load (HG) meal matched for carbohydrates (121 g). %26lt;br%26gt;Methods On Visit 1, participants consumed an evening meal. On follow-up Visit 2, a variable-target glucose clamp was performed to reproduce glucose and insulin levels from Visit 1. Adopting stable-label tracer dilution methodology, we measured endogenous glucose production on Visit 2 and subtracted it from total glucose appearance measured on Visit 1 to obtain meal-attributable glucose appearance. %26lt;br%26gt;Results After the LG meal, 25%, 50% and 75% of cumulative glucose appearance was at 88 +/- 21, 175 +/- 39 and 270 +/- 54 min (mean +/- SD), whereas glucose from the HG meal appeared significantly faster at 56 +/- 12, 100 +/- 25 and 153 +/- 39 min (p%26lt;0.001 to 0.003), and resulted in a 50% higher peak appearance (p%26lt;0.001). Higher apparent bioavailability by 15% (p=0.037) was observed after the LG meal. We documented a 20 min deceleration of dietary mixed carbohydrates compared with dietary glucose for the HG meal and a twofold deceleration for the LG meal. %26lt;br%26gt;Conclusions/interpretation Absorption patterns may be influenced by glycaemic load and/or meal composition, affecting optimum prandial insulin dosing in type 1 diabetes.

• 出版日期2013-5