Dietary substitution of medium chain triglycerides in subjects with non-insulin-dependent diabetes mellitus in an ambulatory setting: impact on glycemic control and insulin-mediated glucose metabolism.
OBJECTIVE
We have previously shown in an acute inpatient setting that dietary substitution of 77.5% of fat kcal as medium chain triglycerides (MCT) increased insulin-mediated glucose metabolism in patients with non-insulin-dependent diabetes mellitus (NIDDM), and that this effect appeared to be mediated by increases in insulin-mediated glucose disposal. The purpose of this study was to test the application of dietary substitution of medium chain triglycerides as an adjunctive tool in ambulatory therapy of NIDDM.


METHODS
Five subjects with NIDDM underwent a baseline 6 hour insulin/glucose euglycemic clamp study, with simultaneous 3H-glucose infusion for calculation of glucose disposal rate and hepatic glucose output. Subjects were then randomized to begin one of two 30-day experimental diets, with long chain (LCT) or medium chain triglycerides (MCT), and subsequent crossover to the other diet. A 6 hour euglycemic clamp was repeated after each diet phase.


RESULTS
Diet records and urinary organic acid excretion indicated a high level of dietary compliance by the study participants. Postprandial blood glucose excursions were less after one month on the diet with MCT than after the LCT diet (p = 0.004). However, fasting serum glucose, serum fructosamine (a measure of glycemia), fasting insulin, hepatic glucose output, and insulin-mediated glucose metabolism were not improved by the dietary substitution of MCT.


CONCLUSIONS
These data indicate that supplementation of a tolerable amount of MCT in a conventional diabetic exchange diet has little impact on glycemic control in subjects with NIDDM in an ambulatory setting.
Yost
T J
TJ
Department of Medicine, University of Colorado Health Sciences Center, Denver 80262.
Erskine
J M
JM
Gregg
T S
TS
Podlecki
D L
DL
Brass
E P
EP
Eckel
R H
RH
D000328:Adult; D000553:Ambulatory Care; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000378:metabolism; D015930:Diet Records; D004041:Dietary Fats / Q000494:pharmacology / Q000627:therapeutic use*; D004435:Eating / Q000502:physiology; D005260:Female; D019270:Fructosamine; D005947:Glucose / Q000378:metabolism*; D015309:Glucose Clamp Technique; D006595:Hexosamines / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D013997:Time Factors; D014280:Triglycerides / Q000494:pharmacology / Q000627:therapeutic use*
D001786:Blood Glucose; D004041:Dietary Fats; D006595:Hexosamines; D007328:Insulin; D014280:Triglycerides; D019270:Fructosamine; D005947:Glucose