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

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.

Effects of different protein content and glycaemic index of ad libitum diets on diabetes risk factors in overweight adults: the DIOGenes multicentre, randomized, dietary intervention trial

“…Moreover, the role of these dietary patterns was more evident in more successful subjects, showing lower HOMA‐IR change values independent of the body weight changes and other main variables. This outcome reinforces previously published observations describing the favourable role of both LGI and high‐protein diets on the weight control methods 22, 50, 53–56. Moreover, these observations clearly support an additional role for both high‐protein and LGI diets in terms of long‐term interventional controlled and randomized trial, in the insulin sensitivity action on weight management strategies of obesity.…”

Effects of different sweet preloads on incretin hormone secretion, gastric emptying, and postprandial glycemia in healthy humans

“…Isomalt is a mixture of disaccharide alcohols with a slow rate of hydrolysis, which results in limited absorption in the small intestine and subsequent fermentation in the colon (47). Although incorporation of isomalt into a diabetic diet has been reported to improve glycemic control (24), the capacity of isomalt to stimulate GLP-1 secretion has not been evaluated.…”

“…Secretion of GLP-1 in response to sucrose increases markedly when malabsorption is induced by the a-glucosidase inhibitor acarbose (21,22). Poorly absorbed sugars such as tagatose and isomalt could potentially have a similar effect (23,24).…”

Empfehlungen zur Ernährung von Personen mit Typ-2-Diabetes mellitus

“…Diese Studie hatte jedoch erhebliche Schwächen, da die Ballaststoffgruppe Lebensmittel mit hohem GI meiden sollte und die Low-GI-Gruppe letztlich einen höheren Ballaststoffverzehr aufwies als die Ballaststoffgruppe. Tatsächlich führte jedoch eine 12-wöchige Substitution von stark blutzuckerwirksamen Kohlenhydraten durch Isomaltulose (Low-GI) bei Patienten mit T2Dm zu einer Reduktion des HbA 1c -Werts und des HOMA-Indexes [168], was auf einen Einfluss des GI unabhängig vom Ballaststoffgehalt der Diät hinweist.…”