Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive
- Carmel E.M. Smart, RD, PHD1,2,
- Megan Evans, RD PGRADDIPDIET3,
- Susan M. O’Connell, MD, FRACP3,4,
- Patrick McElduff, PHD2,
- Prudence E. Lopez, MD2,5,
- Timothy W. Jones, MD, FRACP3,4,6,
- Elizabeth A. Davis, MD, PHD3,4,6 and
- Bruce R. King, MD, PHD1,5⇑
- 1Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
- 2Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, New South Wales, Australia
- 3Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- 4Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- 5Faculty of Health, School of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
- 6School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- Corresponding author: Bruce R. King, .
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.
- Received May 20, 2013.
- Accepted July 27, 2013.
- © 2013 by the American Diabetes Association.
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