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    Home > Active Ingredient News > Endocrine System > Professor Su Heng: Adjusting the order of meals can significantly improve postprandial blood sugar fluctuations

    Professor Su Heng: Adjusting the order of meals can significantly improve postprandial blood sugar fluctuations

    • Last Update: 2022-05-28
    • Source: Internet
    • Author: User
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    Edited by Yimaitong, please do not reprint without permission
    .

    From April 15th to April 17th, the 2022 13th Peking University Hospital Standardized Diagnosis and Treatment Forum for Endocrine and Metabolic Diseases, hosted by the Department of Endocrinology of Peking University First Hospital and Beijing Diabetes Prevention Association, was held in the Dream Hall of Peking University First Hospital.
    At the same time, multiple sub-venues will be set up for online real-time broadcast
    .

    This forum has a luxurious lineup, gathered experts and scholars in the field of endocrinology from all over the country, and brought a wonderful academic feast to the participants
    .

    At the meeting, Professor Su Heng from the First People's Hospital of Yunnan Province gave a wonderful academic sharing on the topic of "The Influence of Meal Order on Postprandial Blood Sugar Fluctuation in Diabetes"
    .

    Expert introduction Professor Su Heng, MD, Chief Physician, Professor, Doctoral Supervisor; Vice President of Kunming University of Science and Technology Affiliated Hospital of Yunnan First People's Hospital; studied at the University of Texas San Antonio Medical Center from 2002 to 2004; China Vice Chairman of Type 1 Diabetes Alliance, Member of Endocrinology and Metabolism Branch of Chinese Medical Doctor Association, Chairman of Endocrinology Branch of Yunnan Medical Association; Leading Medical Talent of Yunnan Province, Young and Middle-aged Academic and Technical Leader of Yunnan Province; Presided over 2 National Natural Science Foundation of China ; Won the first, second, and third prizes for scientific and technological achievements in Yunnan Province, and the second and third prizes for health science and technology achievements in Yunnan Province
    .

     What factors affect blood sugar fluctuations? At the beginning of the lecture, Professor Su pointed out that the blood sugar level of the human body is not static, but a constantly changing curve affected by many factors
    .

    The fluctuation of blood sugar in healthy people will be in a relatively stable range; while in diabetics, the range of blood sugar fluctuation will be greatly increased due to the impaired glucose metabolism regulation mechanism
    .

    The blood glucose regulation mechanism is complex and delicate, regulated by multiple systems, multiple mechanisms, and multiple hormone levels (Figure 1)
    .

    This mechanism responds to many external factors such as exercise, diet, circadian rhythm, etc.
    , all of which may affect the body's blood sugar fluctuations
    .

    Figure 1 The regulation mechanism of human blood sugar The harm of blood sugar fluctuations - why is postprandial blood sugar so important? In recent years, with the deepening of research, people's understanding of the harm of blood sugar fluctuations has become more and more in-depth and comprehensive
    .

    The large fluctuation of blood glucose will be involved in the progression of diabetic complications by activating oxidative stress, causing vascular endothelial dysfunction, activating coagulation and inflammatory responses,
    etc.

    (Fig.
    2) Fig.
    2 The pathway of blood glucose fluctuation in the progression of chronic diabetes complications.
    The blood glucose level at 2h of OGTT in healthy people is also closely related to the risk of cardiovascular disease (CVD) and stroke
    .

    As shown in Figure 3, longitudinal studies have shown that healthy people with OGTT 2h blood glucose levels above the 97.
    5% percentile upper limit have a significantly higher risk of CVD and cerebrovascular disease than others after 20 years of follow-up rise
    .

    Figure 3 The effect of OGTT 2h blood glucose level on the risk of CVD and other diseases.
    A study in 2011 also showed that the mean glucose excursion amplitude (MAGE) in diabetic patients was a risk factor for coronary artery disease independent of glycated hemoglobin (HbA1c).
    Persistent hyperglycemic states are stronger
    .

    (Fig.
    4) Fig.
    4 MAGE is an independent risk factor for CAD In addition to its effect on macrovascular disease, some domestic studies have also shown that blood glucose fluctuations in patients with type 2 diabetes are significantly correlated with microglycemia
    .

    For diabetic patients with better control of blood sugar fluctuations, relevant clinical trials have confirmed that the improvement of cardiovascular outcomes is significantly better than that of diabetic patients who do not control blood sugar fluctuations (Figure 5), which also reflects the control of blood sugar fluctuations.
    , which can bring cardiovascular benefits to patients with diabetes
    .

    Figure 5 The effect of using acarbose to control postprandial blood sugar and reduce the range of blood sugar fluctuations on the incidence of cardiovascular disease.
    Reasonable adjustment of meal sequence can significantly improve postprandial blood sugar fluctuations.
    This applies to both healthy and diabetic patients
    .

    Studies have shown that: ➤ In young people with normal glucose tolerance, a mixed preload of protein and fat can reduce the peak blood glucose after OGTT by 32%
    .

    (Fig.
    6a) ➤ In patients with impaired glucose tolerance, a mixed preload of protein and fat resulted in a 37% reduction in peak blood glucose after OGTT
    .

    (Fig.
    6b) Fig.
    6 The effect of protein and fat preload on blood glucose peaks after OGTT in different populations.
    The blood sugar peak is reduced by about 50%, and the peak arrival time is delayed by 30 to 60 minutes
    .

    (Figure 7) ➤ In patients with impaired glucose tolerance, consuming protein and vegetables before carbohydrates can reduce postprandial blood glucose levels by 39%
    .

    (Fig.
    8) ➤ The effect was more pronounced for patients with established type 2 diabetes
    .

    (Fig.
    9) Fig.
    7 The effect of different kinds of food meal order on blood glucose peak in normal glucose tolerance patientsFig.
    8 The effect of different kinds of food meal order on postprandial blood glucose in patients with impaired glucose toleranceFig.
    9 Different kinds of food meal order for type 2 diabetes patients Influence of postprandial blood glucose in patients with gestational diabetes, clinical studies have also reached similar conclusions: the dietary strategy of macronutrient preload can significantly reduce postprandial blood glucose and maintain fasting blood glucose after the strategy for a period of time
    .

    (Fig.
    10) Fig.
    10 The effect of macronutrient preload on postprandial and fasting blood glucose in patients with gestational diabetes.
    For patients with type 1 diabetes, the dietary strategy of adjusting the order of meals is also effective
    .

    In a clinical study that Professor Su Heng participated in, for children with type 1 diabetes, the protein preload meal and the mixed meal also showed a significant difference in the post-blood glucose of the subjects
    .

    As shown in Figure 11: ➤ The blood glucose began to rise 30 minutes after the subjects who ate the mixed meal, and the blood glucose peaked at 150 minutes after the meal and maintained until 180 minutes; ➤ The subjects who ate the protein preload meal began to eat 90 minutes after eating.
    The blood sugar began to rise only after 20 minutes, and the blood sugar peaked at 200 minutes after a meal and maintained until 300 minutes, and the blood sugar peak was significantly reduced
    .

    Figure 11 Effects of different meals on postprandial blood sugar in children with type 1 diabetes Mechanisms of how meal order affects blood sugar fluctuations For the mechanism of how meal order affects postprandial blood sugar and blood sugar fluctuations, Professor Su Heng briefly reviewed the available evidence In summary, it can be roughly divided into the following aspects: ➤ delay gastric emptying; ➤ delay intestinal glucose absorption; ➤ promote insulin and incretin release; ➤ inhibit hepatic insulin uptake and reduce insulin clearance rate; ➤ enhance Glucose uptake by insulin-sensitive tissues; ➤ Reduction of endogenous glucose production
    .

    Summary Finally, Professor Su Heng made a brief summary of the content shared this time: ➤In normal glucose tolerance, impaired glucose tolerance and diabetic populations, it has been confirmed that consuming protein and fat before meals or changing the meal sequence of macronutrients can significantly reduce the risk of postprandial consumption.
    Blood sugar, reducing blood sugar fluctuations; ➤ The hypoglycemic mechanism is related to delaying gastric emptying, promoting glucose-stimulated insulin secretion, and reducing hepatic glucose clearance; ➤ Pre-loading meal patterns of protein and fat intake before meals or adjusting the meal sequence of macronutrients It has the potential to become a simple, effective, safe and inexpensive new method for the prevention and management of postprandial hyperglycemia in diabetes; ➤ There are relatively few studies on the effect of meal order on blood sugar fluctuations in type 1 diabetes, preprandial insulin injection time, hypoglycemia risk And the long-term effect of meal order on blood sugar may be the focus of the next research
    .


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