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Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive

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Smart, Carmel E.M., Evans, Megan, O’Connell, Susan M., McElduff, Patrick, Lopez, Prudence E., Jones, Timothy W., Davis, Elizabeth A., King, Bruce R.·2013·Diabetes Care
DOI 10.2337/dc13-1195PMC PMC3836096
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Abstract

OBJECTIVE: To determine the separate and combined effects of high-protein (HP) and high-fat (HF) meals, with the same carbohydrate content, on postprandial glycemia in children using intensive insulin therapy (IIT). RESEARCH DESIGN AND METHODS: Thirty-three subjects aged 8-17 years were given 4 test breakfasts with the same carbohydrate amount but varying protein and fat quantities: low fat (LF)/low protein (LP), LF/HP, HF/LP, and HF/HP. LF and HF meals contained 4 g and 35 g fat. LP and HP meals contained 5 g and 40 g protein. An individually standardized insulin dose was given for each meal. Postprandial glycemia was assessed by 5-h continuous glucose monitoring. RESULTS: Compared with the LF/LP meal, mean glucose excursions were greater from 180 min after the LF/HP meal (2.4 mmol/L [95% CI 1.1-3.7] vs. 0.5 mmol/L [-0.8 to 1.8]; P = 0.02) and from 210 min after the HF/LP meal (1.8 mmol/L [0.3-3.2] vs. -0.5 mmol/L [-1.9 to 0.8]; P = 0.01). The HF/HP meal resulted in higher glucose excursions from 180 min to 300 min (P < 0.04) compared with all other meals. There was a reduction in the risk of hypoglycemia after the HP meals (odds ratio 0.16 [95% CI 0.06-0.41]; P < 0.001). CONCLUSIONS: Meals high in protein or fat increase glucose excursions in youth using IIT from 3 h to 5 h postmeal. Protein and fat have an additive impact on the delayed postprandial glycemic rise. Protein had a protective effect on the development of hypoglycemia.

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Figure 1 Mean postprandial glucose excursions from 0 to 300 min for 33 subjects after test meals of LF/LP (●), LF/HP (♦), HF/LP (▲), and HF/HP (□) content. Carbohydrate amount was the same in all meals. There were significant differences in glucose excursions between meal types from 150 to 300 min (P < 0.03). Error bars represent 95% CIs.
Figure 1 Mean postprandial glucose excursions from 0 to 300 min for 33 subjects after test meals of LF/LP (●), LF/HP (♦), HF/LP (▲), and HF/HP (□) content. Carbohydrate amount was the same in all meals. There were significant differences in glucose excursions between meal types from 150 to 300 min (P < 0.03). Error bars represent 95% CIs.CC BY-NC-ND · PubMed Central

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Metadata

Authors
Smart, C. E. M., Evans, M., O’Connell, S. M., McElduff, P., Lopez, P. E., Jones, T. W., Davis, E. A., & King, B. R.
Affiliations
  • Hunter Medical Research Institute (AU)
  • Princess Margaret Hospital for Children (AU)
  • Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
  • The Kids Research Institute Australia (AU)
  • John Hunter Children's Hospital (AU)
Corresponding author
King, Bruce R.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2013-11-13
Volume
36
Issue
12
Pages
3897-3902
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc13-1195
PMC
PMC3836096
OpenAlex
W2161131222
Cited by
240
References
19
Citations by year
2026: 15 · 2025: 16 · 2024: 26 · 2023: 24 · 2022: 15 · 2021: 26 · 2020: 21 · 2019: 19 · 2018: 19 · 2017: 18 · 2016: 17 · 2015: 12 · 2014: 10 · 2013: 1
FWCI
10.49
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 1 diabetes, children, postprandial blood glucose, dietary protein, dietary fat, protein-rich meals, high-fat meal, intensive insulin therapy, hypoglycemia, additive effects, breakfast, continuous glucose monitoring
MeSH terms
Adolescent, Blood Glucose, Child, Diabetes Mellitus, Type 1, Dietary Fats, Dietary Proteins, Female, Follow-Up Studies, Humans, Insulin, Male, Cross-Over Studies, Postprandial Period, Infusions, Subcutaneous

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