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Diabetes Obes Metab. 2019 Feb;21(2):377-381. doi: 10.1111/dom.13503. Epub 2018 Sep 10.

The impact of food order on postprandial glycaemic excursions in prediabetes.

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Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, & Metabolism, Weill Cornell Medicine, New York, New York.
Institute of Human Nutrition, Columbia University, New York, New York.
Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York.
Rockefeller University, New York, New York.


Data suggest that nutrient order during a meal significantly impacts postprandial glucose and insulin excursions in type 2 diabetes, while its effects in prediabetes have not been reported. Fifteen participants with prediabetes consumed the same meal on 3 days in random order: carbohydrate first, followed 10 minutes later by protein and vegetables (CF); protein and vegetables first, followed 10 minutes later by carbohydrate (PVF); or vegetables first followed by protein and carbohydrate (VF). Blood was sampled for glucose and insulin measurements at 0, 30, 60, 90, 120, 150 and 180 minutes. Incremental glucose peaks were similarly attenuated by >40% in the PVF and VF meal conditions compared with CF. The incremental area under the curve for glucose was 38.8% lower following the PVF meal order, compared with CF, and postprandial insulin excursions were significantly lower in the VF meal condition compared with CF. The CF meal pattern showed marked glycaemic variability whereas glucose levels were stable in the PVF and VF meal conditions. Food order presents a novel, simple behavioural strategy to reduce glycaemic excursions in prediabetes.


clinical physiology; dietary intervention


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