Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive

• DOI: 10.2337/dc13-1195
• Publication Date: 2013-10-30T02:53:21Z
• Authors: Carmel E.M. Smart; Megan Evans; Susan M. O’Connell; Patrick McElduff; Prudence E. Lopez; Timothy W. Jones; Elizabeth A. Davis; Bruce R. King
• Keywords: Blood Glucose; Male; 571; Adolescent; Infusions, Subcutaneous; 03 medical and health sciences; intensive insulin therapy; 0302 clinical medicine; high protein diet; Humans; Insulin; Child; Original Research; 2. Zero hunger; Cross-Over Studies; diabetes; high fat diet; postprandial glycemia; Postprandial Period; Dietary Fats; 3. Good health; Diabetes Mellitus, Type 1; fat increase; Female; Dietary Proteins; Follow-Up Studies

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.