title: A randomized cross-over trial of the postprandial effects of three different diets in patients with type 2 diabetes.
abstract: BACKGROUND
  In the clinic setting both fasting levels of glucose and the area under the curve (AUC) of glucose, by determination of HbA1c levels, are used for risk assessments, in type 2 diabetes (NIDDM). However little is known about postprandial levels, and hence AUC, regarding other traditional risk factors such as insulin and blood-lipids and how this is affected by different diets.
  
  
  OBJECTIVE
  To study postprandial effects of three diets, during a single day, in NIDDM.
  
  
  METHODS
  A low-fat diet (45-56 energy-% from carbohydrates), and a low-carbohydrate diet (16-24 energy-% from carbohydrates) was compared with a Mediterranean-style diet (black coffee for breakfast and the same total-caloric intake as the other two diets for lunch with red wine, 32-35 energy-% from carbohydrates) in a randomized cross-over design. Total-caloric intake/test-day at the clinic from food was 1025-1080 kCal in men and 905-984 kCal in women. The test meals were consumed at a diabetes ward under supervision.
  
  
  RESULTS
  Twenty-one participants were recruited and 19 completed the studies. The low-carbohydrate diet induced lower insulin and glucose excursions compared with the low-fat diet (p<0.0005 for both AUC). The insulin-response following the single Mediterranean-style lunch-meal was more pronounced than during the low-fat diet lunch (insulin increase-ratio of the low-fat diet: 4.35 ± 2.2, of Mediterranean-style diet: 8.12 ± 5.2, p = 0.001) while postprandial glucose levels were similar. The increase-ratio of insulin correlated with the elevation of the incretin glucose-dependent insulinotropic-polypeptide following the Mediterranean-style diet lunch (Spearman, r = 0.64, p = 0.003).
  
  
  CONCLUSIONS
  The large Mediterranean-style lunch-meal induced similar postprandial glucose-elevations as the low-fat meal despite almost double amount of calories due to a pronounced insulin-increase. This suggests that accumulation of caloric intake from breakfast and lunch to a single large Mediterranean style lunch-meal in NIDDM might be advantageous from a metabolic perspective.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01522157 NCT01522157.
authors: Department of Medical and Health Sciences, Faculty of Health Science, Linköping University, Linköping, Sweden.
authors: Hanna
authors: H
authors: Fernemark
authors: Christine
authors: C
authors: Jaredsson
authors: Bekim
authors: B
authors: Bunjaku
authors: Ulf
authors: U
authors: Rosenqvist
authors: Fredrik H
authors: FH
authors: Nystrom
authors: Hans
authors: H
authors: Guldbrand
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000378:metabolism*; D004032:Diet; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D008055:Lipids