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Diabetes Obes Metab. 2018 Nov;20(11):2695-2699. doi: 10.1111/dom.13445. Epub 2018 Jul 18.

Impact of macronutrient content of meals on postprandial glucose control in the context of closed-loop insulin delivery: A randomized cross-over study.

Author information

1
Metabolic Diseases Unit, Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada.
2
Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.
3
School of Public Health, Social and Preventive Medicine Department, Université de Montréal, Montreal, Quebec, Canada.
4
Research Center of the Université de Montréal Hospital Center (CRCHUM), Montreal, Quebec, Canada.
5
Montreal Diabetes Research Center (MDRC), Montreal, Quebec, Canada.

Abstract

The aim of this randomized four-way cross-over study was to examine the effect of added protein and/or fat in standard meals with a fixed carbohydrate content on postprandial glucose control with closed-loop insulin delivery in adults with type 1 diabetes. Participants (n = 15) consumed breakfast meals with a fixed carbohydrate content (75 ± 1 g) and added protein and/or fat (35 ± 2 g): (1) carbohydrate-only (standard), (2) high protein (HP), (3) high fat (HF) and (4) high fat + protein (HFHP). The closed-loop insulin delivery algorithm generated insulin bolus and infusion rates. The addition of fat, protein or both did not impact 5-hour post-meal sensor glucose area under the curve (AUC) (main outcome), mean sensor glucose or glycaemic peak as compared with a standard meal (P > 0.05). However, time to glycaemic peak was delayed by 40 minutes (P = 0.03) and 5-hour post-meal basal insulin requirements were 39% higher (P = 0.04) with an HFHP meal compared with a standard meal. In conclusion, in the context of closed-loop insulin delivery, protein and/or fat meal content affects the timing of postprandial glycaemic peak, insulin requirements and late glycaemic excursion, without impacting overall 5-hour AUC.

KEYWORDS:

glycaemic control; insulin delivery; insulin pump therapy; macronutrients; type 1 diabetes

PMID:
29931719
DOI:
10.1111/dom.13445

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