title: Breakfast glycaemic response in patients with type 2 diabetes: effects of bedtime dietary carbohydrates.
abstract: OBJECTIVE
  Bedtime carbohydrate (CHO) intake in patients with type-2 diabetes may improve glucose tolerance at breakfast the next morning. We examined the 'overnight second-meal effect' of bedtime supplements containing 'rapid' or 'slow' CHOs.
  
  
  METHODS
  Randomized cross-over study with three test-periods, each consisting of two days on a standardized diet, followed by a breakfast tolerance test on the third morning.
  
  
  METHODS
  The Lundberg Laboratory for Diabetes Research, Sahlgrenska University Hospital, Göteborg, Sweden.
  
  
  METHODS
  Sixteen patients with type 2 diabetes on oral agents and/or diet.
  
  
  METHODS
  Two different bedtime (22.00 h) CHO supplements (0.46 g available CHO/kg body weight) were compared to a starch-free placebo ('normal' food regimen). The CHOs were provided as uncooked cornstarch (slow-release CHOs) or white bread (rapid CHOs).
  
  
  RESULTS
  On the mornings after different bedtime meals we found similar fasting glucose, insulin, free fatty acid and lactate levels. However, the glycaemic response after breakfast was 21% less after uncooked cornstarch compared to placebo ingestion at bedtime (406 +/- 46 vs 511 +/- 61 mmol min l(-1), P < 0.01). In contrast, it did not differ when the evening meal consisted of white bread (451 +/- 57 mmol min l(-1)) compared to placebo. According to an in vitro analysis, uncooked cornstarch contained approximately 4 times more slowly digestible starch as compared to white bread.
  
  
  CONCLUSIONS
  A bedtime meal providing uncooked cornstarch improved breakfast tolerance the next morning while, in contrast, this was not found following a bedtime meal of white bread. The results are consistent, therefore, with the concept that an increased intake of slowly digestible carbohydrates exert an overnight second-meal effect in patients with type 2 diabetes.
authors.affiliation: The Lundberg Laboratory for Diabetes Research, Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Axelsen
authors.forename: R
authors.initials: R
authors.lastname: Arvidsson Lenner
authors.forename: P
authors.initials: P
authors.lastname: Lönnroth
authors.forename: U
authors.initials: U
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism*; D004063:Digestion; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007773:Lactates / Q000097:blood; D008297:Male; D008875:Middle Aged; D013213:Starch / Q000008:administration & dosage / Q000378:metabolism; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D007773:Lactates; D013213:Starch