M. Axelsen et al., Breakfast glycaemic response in patients with type 2 diabetes: Effects of bedtime dietary carbohydrates, EUR J CL N, 53(9), 1999, pp. 706-710
Objectives: Bedtime carbohydrate (CHO) intake in patients with type-2 diabe
tes may improve glucose tolerance at breakfast the next morning. We examine
d the 'overnight second-meal effect' of bedtime supplements containing 'rap
id' or 'slow' CHOs.
Design: Randomized cross-over study with three test-periods, each consistin
g of two days on a standardized diet, followed by a breakfast tolerance tes
t on the third morning.
Setting: The Lundberg Laboratory for Diabetes Research, Sahlgrenska Univers
ity Hospital, Goteborg, Sweden.
Subjects: Sixteen patients with type 2 diabetes on oral agents and/or diet.
Interventions: Two different bedtime (22.00 h) CHO supplements (0.46 g avai
lable CHO/kg body weight) were compared to a starch-free placebo ('normal'
food regimen). The CHOs were provided as uncooked cornstarch (slow-release
CHOs) or white bread (rapid CHOs).
Results: On the mornings after different bedtime meals we found similar fas
ting glucose, insulin, free fatty acid and lactate levels. However, the gly
caemic response after breakfast was 21% less after uncooked cornstarch comp
ared to placebo ingestion at bedtime (406 +/- 46 vs 51 +/- 61 mmol min l(-1
), P < 0.01). In contrast, it did not differ when the evening meal consiste
d of white bread (451 +/- 57 mmol min l(-1)) compared to placebo. According
to an in vitro analysis, uncooked cornstarch contained similar to 4 times
moro slowly digestible starch as compared to white bread.
Conclusions: A bedtime meal providing uncooked cornstarch improved breakfas
t tolerance the next morning while, in contrast, this nas not found followi
ng a bedtime meat of white bread. The results are consistent, therefore, wi
th the concept that an increased intake of slowly digestible carbohydrates
exert an overnight second-meal effect in patients with type 2 diabetes.