Impact of postprandial glycaemia on health and prevention of disease

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Abstract

Postprandial glucose, together with related hyperinsulinemia and lipidaemia, has been implicated in the development of chronic metabolic diseases like obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this review, available evidence is discussed on postprandial glucose in relation to body weight control, the development of oxidative stress, T2DM, and CVD and in maintaining optimal exercise and cognitive performance. There is mechanistic evidence linking postprandial glycaemia or glycaemic variability to the development of these conditions or in the impairment in cognitive and exercise performance. Nevertheless, postprandial glycaemia is interrelated with many other (risk) factors as well as to fasting glucose. In many studies, meal-related glycaemic response is not sufficiently characterized, or the methodology with respect to the description of food or meal composition, or the duration of the measurement of postprandial glycaemia is limited. It is evident that more randomized controlled dietary intervention trials using effective low vs. high glucose response diets are necessary in order to draw more definite conclusions on the role of postprandial glycaemia in relation to health and disease. Also of importance is the evaluation of the potential role of the time course of postprandial glycaemia.

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Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.

Jean-Louis Chiasson, Robert G Josse, Ramon Gomis … (2002)

The worldwide increase in type 2 diabetes mellitus is becoming a major health concern. We aimed to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance to type 2 diabetes. In a multicentre, placebo-controlled randomised trial, we randomly allocated patients with impaired glucose tolerance to 100 mg acarbose or placebo three times daily. The primary endpoint was development of diabetes on the basis of a yearly oral glucose tolerance test (OGTT). Analyses were by intention to treat. We randomly allocated 714 patients with impaired glucose tolerance to acarbose and 715 to placebo. We excluded 61 (4%) patients because they did not have impaired glucose tolerance or had no postrandomisation data. 211 (31%) of 682 patients in the acarbose group and 130 (19%) of 686 on placebo discontinued treatment early. 221 (32%) patients randomised to acarbose and 285 (42%) randomised to placebo developed diabetes (relative hazard 0.75 [95% CI 0.63-0.90]; p=0.0015). Furthermore, acarbose significantly increased reversion of impaired glucose tolerance to normal glucose tolerance (p<0.0001). At the end of the study, treatment with placebo for 3 months was associated with an increase in conversion of impaired glucose tolerance to diabetes. The most frequent side-effects to acarbose treatment were flatulence and diarrhoea. Acarbose could be used, either as an alternative or in addition to changes in lifestyle, to delay development of type 2 diabetes in patients with impaired glucose tolerance.

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Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.

J Stamler, O Vaccaro, J Neaton … (1993)

To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death. Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11-13 yr). Participants were 347,978 men aged 35-57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality. Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level--overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels. These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.

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Preserved incretin activity of glucagon-like peptide 1 [7-36 amide] but not of synthetic human gastric inhibitory polypeptide in patients with type-2 diabetes mellitus.

M. Nauck, M. M. Heimesaat, C Orskov … (1993)

In type-2 diabetes, the overall incretin effect is reduced. The present investigation was designed to compare insulinotropic actions of exogenous incretin hormones (gastric inhibitory peptide [GIP] and glucagon-like peptide 1 [GLP-1] [7-36 amide]) in nine type-2 diabetic patients (fasting plasma glucose 7.8 mmol/liter; hemoglobin A1c 6.3 +/- 0.6%) and in nine age- and weight-matched normal subjects. Synthetic human GIP (0.8 and 2.4 pmol/kg.min over 1 h each), GLP-1 [7-36 amide] (0.4 and 1.2 pmol/kg.min over 1 h each), and placebo were administered under hyperglycemic clamp conditions (8.75 mmol/liter) in separate experiments. Plasma GIP and GLP-1 [7-36 amide] concentrations (radioimmunoassay) were comparable to those after oral glucose with the low, and clearly supraphysiological with the high infusion rates. Both GIP and GLP-1 [7-36 amide] dose-dependently augmented insulin secretion (insulin, C-peptide) in both groups (P < 0.05). With GIP, the maximum effect in type-2 diabetic patients was significantly lower (by 54%; P < 0.05) than in normal subjects. With GLP-1 [7-36 amide] type-2 diabetic patients reached 71% of the increments in C-peptide of normal subjects (difference not significant). Glucagon was lowered during hyperglycemic clamps in normal subjects, but not in type-2 diabetic patients, and further by GLP-1 [7-36 amide] in both groups (P < 0.05), but not by GIP. In conclusion, in mild type-2 diabetes, GLP-1 [7-36 amide], in contrast to GIP, retains much of its insulinotropic activity. It also lowers glucagon concentrations.

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Author and article information

Journal

Journal ID (nlm-ta): Obes Rev

Journal ID (iso-abbrev): Obes Rev

Journal ID (publisher-id): obr

Title: Obesity Reviews

Publisher: Blackwell Publishing Ltd (Oxford, UK )

ISSN (Print): 1467-7881

ISSN (Electronic): 1467-789X

Publication date (Print): October 2012

Volume: 13

Issue: 10

Pages: 923-984

Affiliations

[1 ]Department of Human Biology, School of Nutrition & Toxicology Research and Metabolism (NUTRIM), Maastricht University Maastricht, the Netherlands

[2 ]Danone Research Center Palaiseau, France

[3 ]Department of Psychology, University of Swansea Wales, UK

[4 ]Division of Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Lund University Lund, Sweden

[5 ]Department of Clinical and Experimental Medicine, University Federico II Naples, Italy

[6 ]Diabetes Center, Department of Internal Medicine, VU University Medical Center Amsterdam, the Netherlands

[7 ]Institute of Psychological Sciences, University of Leeds Leeds, UK

[8 ]Kellogg Europe Den Bosch, the Netherlands

[9 ]Department of Biomedical Sciences and Novo Nordisk Foundation Centre of Basic Metabolic Research, University of Copenhagen Copenhagen, Denmark

[10 ]Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Center for European Nutrition, Safety and Health, Centre Hospitalier Lyon Sud Lyon, France

[11 ]ILSI Europe Brussels, Belgium

[12 ]Südzucker/BENEO Group Obrigheim, Germany

[13 ]Kraft Foods, R&D Centre, Nutrition Department Saclay, France

Author notes

Address for correspondence: A Meheust, ILSI Europe a.i.s.b.l., Av. E. Mounier 83, Box 6, B-1200 Brussels, Belgium. E-mail: publications@ 123456ilsieurope.be

Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms

Article

DOI: 10.1111/j.1467-789X.2012.01011.x

PMC ID: 3494382

PubMed ID: 22780564

SO-VID: 9ffd5c4c-545a-41fb-89f2-bc719757597c

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Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

History

Date received : 06 February 2012

Date revision received : 11 April 2012

Date accepted : 27 April 2012

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Impact of postprandial glycaemia on health and prevention of disease

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Cardiovascular Innovations and Applications

Most cited references 393

Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.

Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial.

Preserved incretin activity of glucagon-like peptide 1 [7-36 amide] but not of synthetic human gastric inhibitory polypeptide in patients with type-2 diabetes mellitus.

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Cited by 132

Most referenced authors 5,843