Effects of Vegetables Consumption Before Carbohydrates on Blood Glucose and GLP-1 Levels Among Diabetic Patients in Indonesia

Dono Indarto, Dwi Nuzulia Rochmah, Budiyanti Wiboworini, Yoga Mulia Pratama, Yohanes Cakrapradipta Wibowo

Abstract


Background: Type 2 Diabetes Mellitus (T2DM) is the prominent public health issue. Pharmacotherapy and diet modification should be integrated into T2DM management.Aims: To investigate the effects of vegetables consumption before carbohydrates on blood glucose and GLP‑1 levels in T2DM patients.

Methods: A non‑randomized quasi experimental study was conducted to recruit T2DM patients who attended at the Gatot Soebroto Central Army Hospital, Jakarta, Indonesia from April to May 2016. The Lemeshow’s formula was used to determine sample size. A total of 12 non‑diabetic and 24 diabetic patients were participated in our study. Glucose levels were measured using a routine hexokinase method while serum GLP‑1 levels were determined using the ELISA. The student t‑test was used to compare two groups with parametric data. The significant difference was at P < 0.05.

Results: Our data showed that T2DM patients who consumed vegetables before carbohydrates, had relatively stable glucose levels at 0, 60 and 120 mins (164.25 ± 86.89 vs 183.5 ± 55.96 vs 167.83 ± 65.53, P = 0.163) and stay lowered within the normal range compared to T2DM patients who consumed vegetables after carbohydrates (165.08 ± 67.89 vs 241.92 ± 68.03 vs 204.92 ± 81.76, P = 0.022). Additionally, GLP‑1 levels remained stable after 60 and 120 min at day 1 (P = 0.816) and day 3 (P = 0.955).

Conclusions: Vegetables consumption before carbohydrate is a promising and simple method of diabetes diet for maintaining blood glucose and GLP‑1 levels and preventing from vascular complication.


Keywords


Blood glucose level; glucagon‑like peptide 1; type 2 diabetes mellitus; vegetable consumption

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References


Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S,

Unwin N, et al. Global and regional diabetes prevalence

estimates for 2019 and projections for 2030 and 2045: Results

from the International Diabetes Federation Diabetes Atlas,

th edition. Diabetes Res Clin Pract 2019;157:107843.

American Diabetes Association. Standards of medical care in

diabetes‑2015 abridged for primary care providers. Clin Diabetes

;33:97‑111.

Ceriello A, Barakat M, Bahendeka S, Colagiuri S, Gerich J,

Hanefeld M, et al. Guideline for management of postmeal

glucose in diabetes. Diabetes Res Clin Pract 2014;103:256‑68.

Avignon A, Radauceanu A, Monnier L. Nonfasting plasma

glucose is a better marker of diabetic control than fasting plasma

glucose in type 2 diabetes. Diabetes Care 1997;20:1822‑6.

Pareek M, Bhatt DL, Nielsen ML, Jagannathan R, Eriksson KF,

Nilsson PM, et al. Enhanced predictive capability of a 1‑hour

oral glucose tolerance test: A prospective population‑based

cohort study. Diabetes Care 2018;41:171‑7.

Holst JJ and Gromada J. Role of incretin hormones in the

regulation of insulin secretion in diabetic and nondiabetic

humans. Am J Physiol Endocrinol Metab 2004;287:E199‑206.

Ahrén B. The dynamic incretin adaptation and type 2 diabetes.

J Clin Endocrinol Metab 2011;96:620‑2.

Boyle JG, Livingstone R, Petrie JR. Cardiovascular benefits of

GLP‑1 agonists in type 2 diabetes: A comparative review. Clin

Sci (Lond) 2018;132:1699‑709.

Davies MJ, D‘Alessio DA, Fradkin J, Kernan WN, Mathieu C,

Mingrone G, et al. Management of hyperglycaemia in type 2

diabetes, 2018. A consensus report by the American Diabetes

Association (ADA) and the European Association for the Study

of Diabetes (EASD). Diabetes Care 2018;41:2669‑2701.

Shukla AP, Andono J, Touhamy SH, Casper A, Iliescu RG,

Mauer E, et al. Carbohydrate‑last meal pattern lowers

postprandial glucose and insulin excursions in type 2 diabetes.

BMJ Open Diabetes Res Care. 2017;5:e000440.

Imai S, Fukui M, Kajiyama S. Effect of eating vegetables before

carbohydrates on glucose excursions in patients with type 2

diabetes. J Clin Biochem Nutr 2014;54:7‑11.

Imai S, Fukui M, Ozasa N, Ozeki T, Kurokawa M, Komatsu M,

et al. Eating vegetables before carbohydrates improves

postprandial glucose excursions. Diabet Med. 2013;30:370‑2.

Nishino K, Sakurai M, Takeshita Y, Takamura T. Consuming

carbohydrates after meat or vegetables lowers postprandial

excursions of glucose and insulin in nondiabetic subjects. J Nutr

Sci Vitaminol (Tokyo) 2018;64:316‑20.

Shukla AP, Dickison M, Coughlin N, Karan A, Mauer E,

Truong W, et al. The impact of food order on postprandial

glycaemic excursions in prediabetes. Diabetes Obes Metab

;21:377‑81.

Ickowitz A, Rowland D, Powell B, Salim MA, Sunderland T.

Forests, Trees, and Micronutrient‑Rich Food Consumption in

Indonesia. PLoS One 2016;11:e0154139.

Kusmiyati F, Lukiwati DR, Kristanto BA, Herwibawa B.

Glycemic index of ten commercially Indonesian rice cultivars.

IOP Conf Ser Earth Environ Sci 2019;250:012028.

Widowati S, Astawan M, Muchtadi D, Wresdiyati T.

Hypoglycemic activity of some Indonesian rice varieties and their

physicochemical properties. Indones J Agric Sci 2006;7:57‑66.

Lwanga SK, Lemeshow S. Sample Size Determination in Health

Studies: A Practical Manual. World Health Organization, Geneva,

Switzerland, 1991.

WHO Expert Consultation. Appropriate body‑mass index for

Asian populations and its implications for policy and intervention

strategies. Lancet 2004;363:157‑63.

Hu ZG, Tan RS, Jin D, Li W, Zhou XY. A low glycemic index

staple diet reduces postprandial glucose values in Asian women

with gestational diabetes mellitus. J Investig Med 2014;62:975‑9.

Rovner AJ, Nansel TR, Gellar L. The effect of a low‑glycemic diet

vs a standard diet on blood glucose levels and macronutrient intake

in children with type 1 diabetes. J Am Diet Assoc 2009;109:303‑7.

Riccardi G, Rivellese AA, Giacco R. Role of glycemic index

and glycemic load in the healthy state, in prediabetes, and in

diabetes. Am J Clin Nutr 2008;87:269S‑74S.

Sheard NF, Clark NG, Brand‑Miller JC, Franz MJ, Pi‑Sunyer FX,

Mayer‑Davis E, et al. Dietary carbohydrate (amount and type) in

the prevention and management of diabetes: A statement by the

american diabetes association. Diabetes Care 2004;27:2266‑71.

Pang J, Xi C, Huang X, Cui J, Gong H, Zhang T. Effects

of excess energy intake on glucose and lipid metabolism in

C57BL/6 Mice. PLoS One 2016;11:e0146675.

Sun EW, de Fontgalland D, Rabbitt P, Hollington P, Sposato L,

Due SL, et al. Mechanisms controlling glucose‑induced

glp‑1 secretion in human small intestine. Diabetes 2017;66:2144‑9.

Domínguez Avila JA, Rodrigo García J, González Aguilar GA,

de la Rosa LA. The antidiabetic mechanisms of polyphenols

related to increased Glucagon‑Like Peptide‑1 (GLP1) and insulin

signaling. Molecules 2017;22:903.

Haldar S, Chia SC, Henry CJ. Polyphenol‑rich curry made

with mixed spices and vegetables increases postprandial plasma

GLP‑1 concentration in a dose‑dependent manner. Eur J Clin

Nutr 2018;72:297‑300.

Cieslik E, Greda A, Adamus W. Contents of polyphenols in fruit

and vegetables. Food Chem 2006;94, 135‑42.

Tian S, Nakamura K, Kayahara H. Analysis of phenolic

compounds in white rice, brown rice, and germinated brown

rice. J Agric Food Chem 2004;52:4808‑13.

Bodnaruc AM, Prud’homme D, Blanchet R, Giroux I. Nutritional

modulation of endogenous glucagon‑like peptide‑1 secretion:

A review. Nutr Metab (Lond) 2016;13:92.

Kubo F, Miyatsuka T, Sasaki S, Takahara M, Yamamoto Y,

Shimo N, et al. Sustained expression of GLP‑1 receptor

differentially modulates β‑cell functions in diabetic

and nondiabetic mice. Biochem Biophys Res Commun

;471:68‑74.

Kameyama N, Maruyama C, Matsui S, Araki R, Yamada Y,

Maruyama T. Effects of consumption of main and side dishes with

white rice on postprandial glucose, insulin, glucose‑dependent

insulinotropic polypeptide and glucagon‑like peptide‑1 responses

in healthy Japanese men. Br J Nutr 2014;111:1632‑40.

Fan J, Johnson MH, Lila MA, Yousef G, de Mejia EG.

Berry and citrus phenolic compounds inhibit dipeptidyl peptidase

IV: Implications in diabetes management. Evid Based Complement

Alternat Med 2013;2013:479505. doi: 10.1155/2013/479505.

ACCORD Study Group. Nine‑year effects of 3.7 years of

intensive glycemic control on cardiovascular outcomes. Diabetes

Care 2016;39:701‑8.

Cavalot F, Pagliarino A, Valle M, Di Martino L, Massucco P,

Anfossi G, et al. Postprandial blood glucose predicts

cardiovascular events and all‑cause mortality in type 2 diabetes

in a 14‑year follow‑up: Lessons from the San Luigi Gonzaga

Diabetes Study. Diabetes Care 2011;34:2237‑43.

Succurro E, Marini MA, Arturi F, Grembiale A, Lugarà M,

Andreozzi F, et al. Elevated one‑hour post‑load plasma glucose

levels identifies subjects with normal glucose tolerance but early

carotid atherosclerosis. Atherosclerosis 2009;207:245‑9.

Vitale M, Vaccaro O, Masulli M, Bonora E, Prato SD,

Giorda CB, et al. Polyphenol intake and cardiovascular risk

factors in a population with type 2 diabetes: The TOSCA.IT

study. Clin Nutr 2017;36:1686‑92.

Tangney CC, Rasmussen HE. Polyphenols, inflammation, and

cardiovascular disease. Curr Atheroscler Rep 2013;15:324.