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Horm Metab Res 2009; 41(12): 886-892
DOI: 10.1055/s-0029-1234107
Humans, Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Improved Metabolic Control After 12-Week Dietary Intervention with Low Glycaemic Isomalt in Patients with Type 2 Diabetes Mellitus

I. Holub1 , A. Gostner1 , S. Hessdörfer1 , S. Theis2 , G. Bender3 , B. Willinger3 , J. Schauber1 , 4 , R. Melcher1 , B. Allolio3 , W. Scheppach1 , 5
  • 1University of Würzburg, Department of Medicine II, Division of Gastroenterology, Würzburg, Germany
  • 2BENEO GmbH, Obrigheim/Pfalz, Germany
  • 3University of Würzburg, Department of Medicine I, Division of Endocrinology, Würzburg, Germany
  • 4University of München, Clinic of Dermatology and Allergology, München, Germany
  • 5Juliusspital Würzburg, Department of Medicine, Würzburg, Germany
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Publication History

received 30.01.2009

accepted 13.07.2009

Publication Date:
21 August 2009 (online)

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Abstract

The polyol isomalt (Palatinit®) is a very low glycaemic sugar replacer. The effect of food supplemented with isomalt instead of higher glycaemic ingredients like sucrose and/or starch hydrolysates on metabolic control in patients with type 2 diabetes was examined in this open study. Thirty-three patients with type 2 diabetes received a diet with foods containing 30 g/d isomalt instead of higher-glycaemic carbohydrates for 12 weeks. Metformin and/or thiazolidindiones were the only concomitant oral antidiabetics allowed during the study. Otherwise, the participants maintained their usual diet during the test phase, but were instructed to refrain from additional sweetened foods. Before start, after 6 weeks and 12 weeks (completion of the study), blood samples were taken and analysed for clinical routine parameters, metabolic, and risk markers. Thirty-one patients completed the study. The test diet was well accepted and tolerated. After 12 weeks, significant reductions were observed for: glycosylated haemoglobin, fructosamine, fasting blood glucose, insulin, proinsulin, C-peptide, insulin resistance (HOMA-IR), and oxidised LDL (an atherosclerosis risk factor). In addition, significant lower nonesterified fatty acid concentrations were found in female participants. Routine blood measurements and blood lipids remained unchanged. The substitution of glycaemic ingredients by isomalt and the consequent on reduction of the glycaemic load within otherwise unchanged diet was accompanied by significant improvement in the metabolic control of diabetes. The present study is in agreement with findings of previous reported studies in human subjects demonstrating beneficial effects of low glycaemic diets on glucose metabolism in patients with diabetes mellitus type 2.

Key words

glycaemic index - glycaemic load - carbohydrate metabolism

References

  • 1 Yach D, Stuckler D, Brownell KD. Epidemiology and economic consequences of the global epidemics of obesity and diabetes.  Nat Med. 2006;  12 62-66
    Search in Google Scholar
  • 2 Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic.  Nature. 2001;  414 782-787
    Search in Google Scholar
  • 3 Dickinson S, Brand-Miller J. Glycemic index, postprandial glycemia and cardiovascular disease.  Curr Opin Lipidol. 2005;  16 69-75
    Search in Google Scholar
  • 4 Ludwig DS, Eckel HE. The glycemic index at 20 y.  Am J Clin Nutr. 2002;  76 S264-S265
    Search in Google Scholar
  • 5 Livesey G, Buss D, Coussement P, Edwards DG, Howlett J, Jonas DA, Kleiner JE, Müller D, Sentko A. Suitability of traditional energy values for novel foods and food ingredients.  Food Control. 2000;  11 249-289
    Search in Google Scholar
  • 6 Gehring F, Karle EJ. Sweetening agent, Palatinit under specific consideration as to microbiological and caries-prophylactic aspects.  Z Ernährungswiss. 1981;  20 96-106
    Search in Google Scholar
  • 7 Langkilde AM, Andersson H, Schweizer TF, Wursch P. Digestion and absorption of sorbitol, maltitol and isomalt from small bowel.  A study in ileostomy subjects. Eur J Clin Nutr. 1994;  48 768-775
    Search in Google Scholar
  • 8 Life Science Research Office . The Evaluation of the Energy of Certain Sugar Alcohols used as Food Ingredients. Bethesda, MD: Life Science Research Office, Federation of the American Society for Experimental Biology 1994
  • 9 Livesey G. Health potential of polyols as sugar replacers, with emphasis on low glyceamic properties.  Nutr Res Rev. 2003;  16 163-289
    Search in Google Scholar
  • 10 Bär A. Factorial calculation model fort he estimation of the physiological caloric value of polyols. In: Hosoxa N, ed Proceedings of the International Symposium on Caloric Evaluation of Carbohydrates. Tokyo: Research Foundation for Sugar Metabolism 1990: 209-257
    Search in Google Scholar
  • 11 Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008.  Diabetes Care. 2008;  31 2281-2283
    Search in Google Scholar
  • 12 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
    Search in Google Scholar
  • 13 Gostner A, Schäffer V, Theis S, Menzel T, Lührs H, Melcher R, Schauber J, Kudlich T, Dusel G, Dorbath D, Kozianowski G, Scheppach W. Effects of isomalt consumption on gastrointestinal and metabolic parameters in healthy volunteers.  Br J Nutr. 2005;  94 575-581
    Search in Google Scholar
  • 14 Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials.  Diabetes Care. 2003;  26 2261-2267
    Search in Google Scholar
  • 15 Opperman AM, Venter CS, Oosthuizen W, Thompson RL, Vortser HH. Meta-analysis of the health effects of using the glycemic index in meal-planning.  Br J Nutr. 2004;  92 367-381
    Search in Google Scholar
  • 16 Livesey G, Taylor R, Hulshof T, Howlett J. Glycemic response and health – a systematic review and meta-analysis: relations between dietary glycemic properties and health outcomes.  Am J Clin Nutr. 2008;  87 ((Suppl)) 258S-268S
    Search in Google Scholar
  • 17 Tushuizen ME, Diamant M, Heine RJ. Postprandial dysmetabolism and cardiovascular disease in type 2 diabetes.  Postgrad Med J. 2005;  81 1-6
    Search in Google Scholar
  • 18 Ginsberg HN, Illingworth DR. Postprandial dyslipidemia: an atherogenic disorder common in patients with diabetes mellitus.  Am J Cardiol. 2001;  88 9H-15H
    Search in Google Scholar
  • 19 Gokulakrishnan K, Deepa R, Velmurugan K, Ravikumar R, Karkuzhali K, Mohan V. Oxidised low-density lipoprotein and intimal medial thickness in subjects with glucose intolerance: the Chennai Urban Rural Epidemiology Study-25.  Metabolism. 2007;  56 245-250
    Search in Google Scholar
  • 20 Hawkins M, Tonelli J, Kishore P, Stein D, Ragucci E, Gitig A, Reddy K. Contribution of elevated free fatty acid levels to the lack of glucose effectiveness in type 2 diabetes.  Diabetes. 2003;  52 2748-2758
    Search in Google Scholar
  • 21 Pilz S, Scharnagl H, Tiran B, Seelhorst U, Wellnitz B, Boehm BO, Schaefer JR, Marz W. Free fatty acids are independently associated with all-cause and cardiovascular mortality in subjects with coronary artery disease.  J Clin Endocrinol Metab. 2006;  91 2542-2547
    Search in Google Scholar
  • 22 Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, Elgrably F, Slama G. Improved plasma glucose control, whole-body glucose utilization, and lipid profile on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial.  Diabetes Care. 2004;  27 1866-1872
    Search in Google Scholar
  • 23 Ren S, Lee H, Hu L, Lu L, Shen GX. Impact of diabetes-associated lipoproteins on generation of fibrinolytic regulators from vascular endothelial cells.  J Clin Endocrinol Metab. 2002;  87 286-291
    Search in Google Scholar
  • 24 Juhan-Vague I, Alessi MC. PAI-1, obesity, insulin resistance and risk of cardiovascular events.  Thrombosis and haemostasis. 1997;  78 656-660
    Search in Google Scholar
  • 25 Clausen P, Feldt-Rassmussen B, Jensen G, Jensen JS. Endothelial haemostatic factors are associated with progression of urinary albumin excretion in clinically healthy subjects: a 4-year prospective study.  Clin Sci. 1999;  97 37-43
    Search in Google Scholar
  • 26 Hayden MR, Tyagi SC. Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic syndrome, and type 2 diabetes mellitus: The urate redox shuttle.  Nutr Metab (Lond). 2004;  1 10
    Search in Google Scholar
  • 27 Kadowaki T, Yamauchi T, Kubota N, Hara K, Ueki K, Tobe K. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome.  J Clin Invest. 2006;  116 1784-1792
    Search in Google Scholar
  • 28 Rothenbacher D, Brenner H, Marz W, Koenig W. Adiponectin, risk of coronary heart disease and correlations with cardiovascular risk markers.  Eur Heart J. 2005;  26 1640-1646
    Search in Google Scholar
  • 29 Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE, Tataranni PA. Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia.  J Clin Endocrinol Metab. 2001;  86 1930-1935
    Search in Google Scholar
  • 30 Qi L, Meigs JB, Liu S, Manson JE, Mantzoros C, Hu FB. Dietary fibers and glycemic load, obesity, and plasma adiponectin levels in women with type 2 diabetes.  Diabetes Care. 2006;  29 1501-1505
    Search in Google Scholar
  • 31 Anderlova K, Kremen J, Dolezalova R, Housova J, Haluzikova D, Kunesova M, Haluzik M. The influence of very-low-calorie diet on serum leptin, soluble leptin receptor, adiponectin and resistin levels in obsese women.  Physiol Res. 2006;  55 277-283
    Search in Google Scholar
  • 32 Bouche C, Rizkalla SW, Luo J, Vidal H, Veronese A, Pacher N, Fouquet C, Lang V, Slama G. Five-week, low-glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men.  Diabetes Care. 2002;  25 822-828
    Search in Google Scholar
  • 33 McMillan-Price J, Petocz P, Atkinson F, O’Neill K, Samman S, Steinbeck K, Caterson I, Brand-Miller J. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial.  Arch Intern Med. 2006;  166 1466-1475
    Search in Google Scholar
  • 34 Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS. A reduced-glycemic load diet in the treatment of adolescent obesity.  Arch Pediatr Adolesc Med. 2003;  157 773-779
    Search in Google Scholar
  • 35 Williams KV, Kelley DE. Metabolic consequences of weight loss on glucose metabolism and insulin action in type 2 diabetes.  Diabetes Obes Metab. 2000;  2 121-129
    Search in Google Scholar
  • 36 Wing RR, Koeske R, Epstein LH, Nowalk MP, Gooding W, Becker D. Long-term effects of modest weight loss in type II diabetes patients.  Arch Intern Med. 1987;  147 749-753
    Search in Google Scholar
  • 37 Watts NB, Spanheimer RG, DiGirolamo M, Gebhart SS, Musey VC, Siddig YK, Phillips LS. Prediction of glucose response to weight loss in patients with non-insulin-dependent diabetes mellitus.  Arch Intern Med. 1990;  150 803-806
    Search in Google Scholar
  • 38 Blonk MC, Jacobs MA, Biesheuvel EH, Weeda-Mannak WL, Heine RJ. Influences on weight loss in type 2 diabetic patients: little long-term benefit from group behaviour therapy and exercise training.  Diabet Med. 1994;  11 449-457
    Search in Google Scholar

Correspondence

I. Holub

University of Würzburg

Department of Medicine II

Division of Gastroenterology

Grombühlstraße 12

Haus Auvera

97080 Würzburg

Germany

Phone: + 49/931/201 458 87

Fax: + 49/931/201 458 29

Email: holub_i@medizin.uni-wuerzburg.de