Optimizing glycemic variability in type 2 diabetes using simple dietary and culinary recommendations to modulate starch digestibility: a randomized controlled trial.

IF 6.9 1区医学 Q1 NUTRITION & DIETETICS

American Journal of Clinical Nutrition Pub Date : 2025-10-13 DOI:10.1016/j.ajcnut.2025.10.007

Maëliss Chisbert, Anne-Laure Castell, Laurie Van Den Berghe, Anne-Esther Breyton, Nathalie Feugier, Charlotte Cuerq, Karim Chikh, Olivier Brack, Martine Laville, Aurélie Goux, Alexandra Meynier, Sophie Vinoy, Julie-Anne Nazare

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引用次数: 0

Abstract

Background: In type 2 diabetes (T2D), postprandial glycemic excursions significantly contribute to glycemic variability (GV) and cardiovascular risk. As starch is the main carbohydrate source controlling its digestibility in the daily diet to promote a gradual glucose release, represents a promising nutritional strategy to reduce GV and improve glycemic control.

Objective: We investigated the feasibility and efficiency of a 3-month dietary intervention emphasizing Slowly Digestible Starch (SDS) through commercial starchy product supply and dietary and culinary counseling, on GV, glycemic control and cardiometabolic profile in patients with T2D with suboptimal control.

Methods: In a randomized, parallel, single-blind, controlled trial, 51 patients with T2D completed a 12-week high-SDS (H-SDS) or low-SDS (L-SDS) diet. Participants received commercial starchy products either high or low in SDS content, with specific dietary/culinary counseling. MAGE (Mean Amplitude of Glycemic Excursions) and other intra- and inter-day GV parameters were assessed by CGMS (Continuous Glucose Monitoring System), as well as glycemic control and cardiometabolic parameters.

Results: Compared to the L-SDS diet, the H-SDS diet significantly lowered MAGE over 12 weeks (β = 30.4 [95% CI: 12.4 to 48.5]; p = 0.0025) and other intra and inter-day GV parameters (standard deviation, coefficient of variation, CONGAs (Continuous Overall Net Glycemic Action), MODD (Mean of Daily Differences) with 96% compliance throughout the study. HbA1c decreased in both groups, with a trend toward a greater reduction in the H-SDS group (β = 0.3 [95% CI: 0.05 to 0.47]; p = 0.0981]), where HbA1c fall below the 7% target. Other cardiometabolic markers were similar between diets.

Conclusions: Modulating starch digestibility represents an effective and accessible strategy for enhancing GV and thus glycemic management in T2D, allowing patients with suboptimal glycemic control to reach recommended glycemic targets. This trial was registered at ClinicalTrials.gov (identifier: NCT03847701; registered on February 18, 2019): https://clinicaltrials.gov/study/NCT03847701.

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通过简单的饮食和烹饪建议调节淀粉消化率来优化2型糖尿病患者的血糖变异性：一项随机对照试验

背景：在2型糖尿病（T2D）中，餐后血糖漂移显著影响血糖变异性（GV）和心血管风险。由于淀粉是日常饮食中控制其消化率以促进葡萄糖逐渐释放的主要碳水化合物来源，是一种很有希望的降低GV和改善血糖控制的营养策略。目的：研究以慢消化淀粉（SDS）为重点，通过商业淀粉产品供应和饮食及烹饪咨询，对控制欠佳的T2D患者GV、血糖控制和心脏代谢状况进行为期3个月的饮食干预的可行性和有效性。方法：在一项随机、平行、单盲、对照试验中，51例T2D患者完成了为期12周的高sds （H-SDS）或低sds （L-SDS）饮食。参与者接受SDS含量高或低的商业淀粉产品，并提供特定的饮食/烹饪咨询。通过CGMS（连续血糖监测系统）评估MAGE（平均血糖漂移振幅）和其他日内和日间GV参数，以及血糖控制和心脏代谢参数。结果：与L-SDS饮食相比，H-SDS饮食在12周内显著降低了MAGE （β = 30.4 [95% CI: 12.4至48.5];p = 0.0025）和其他日内和日间GV参数(标准差、变异系数、CONGAs（连续总体净血糖作用）、MODD（日均差异均值），整个研究的依从性为96%。两组HbA1c均下降，H-SDS组有更大的下降趋势（β = 0.3 [95% CI: 0.05至0.47];p = 0.0981]）， HbA1c低于7%的目标。其他心脏代谢指标在不同饮食之间是相似的。结论：调节淀粉消化率是一种有效且可行的策略，可增强GV，从而改善T2D患者的血糖管理，使血糖控制欠佳的患者达到推荐的血糖目标。该试验注册于ClinicalTrials.gov（标识符：NCT03847701；注册于2019年2月18日）：https://clinicaltrials.gov/study/NCT03847701。

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来源期刊

American Journal of Clinical Nutrition 医学-营养学

CiteScore

12.40

自引率

4.20%

发文量

332

审稿时长

38 days

期刊介绍： American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Purpose: The purpose of AJCN is to: Publish original research studies relevant to human and clinical nutrition. Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits. Encourage public health and epidemiologic studies relevant to human nutrition. Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches. Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles. Peer Review Process: All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.