Impact of Diet Composition on Blood Glucose Regulation

Figures & data

Figure 1 Potential for dietary factors to reduce blood glucose levels and impact on β-cell function and associated biomarkers.GSIS, glucose-stimulated insulin secretion.

Table 1 Carbohydrates and carbohydrate foods and postprandial glycemic control in healthy or diabetic individuals

Reference	Design	Test products	Control	Study subjects	Duration	Glucose	Insulin
Larsen et al. 2000	Randomized crossover	Breakfast (CHO 50 g) Cooked polished rice: NP, TP, PP	WB	9 (6M/3F), T2DM, BMI = 26.6	3 h	iAUC: NP, TP, PP < control	iAUC: NP, TP, PP < control
Hallström et al. 2011	Randomized crossover	Breakfast(CHO 50 g) EAWB, EAWB-LA, WB	WB	14 (7F/7M), healthy, BMI = 22.2	3 h	iAUC (120 min): EAWB, EAWB-LA < WB	iAUC (120 min) ns
Granfeldt et al. 1995	Randomized crossover	Breakfast (CHO 50 g) raw rolled oats (muesli), boiled rolled oats (porridge), boiled intact oat, boiled intact wheat	WB	9 M, healthy, 65–70 years, BMI 26.1	3 h	iAUC (90 min): muesli, porridge ns; intact oat, wheat < control	iAUC (90 min): muesli, porridge ns; intact oat, wheat < control
Granfeldt et al. 2000	Randomized crossover	Breakfast (CHO 50 g) Oat flakes; thin roasted, thin roasted/steamed, thick raw, thick roasted, thick steamed Barley flakes: thin, thick steamed	WB	10 (5M/5F), healthy, BMI 21.0	3 h	iAUC (120 min): Oat - thick roasted steamed < control; thick raw < thin roasted/steamed Barley - ns	iAUC 120 min Oat - thick steamed and thick roasted < control Barley - ns
Frid et al. 2005	Randomized crossover	Breakfast (CHO 50 g) WB: whey, lactose and lean ham Standardized Lunch (CHO 45 g) Mashed potatoes/meatballs: whey, lactose and lean ham	WB with ham + lactose	14 (6M/8F), T2DM, BMI 26.2	4 h after breakfast 3 h after lunch	iAUC: Breakfast – ns Lunch - whey < control	iAUC: Breakfast - whey > control Lunch - whey > control
Nilsson et al. 2007	Randomized crossover	Breakfast (CHO 25 g) Glc Drink: whey (W), Lys, Thr (2AA), Leu, Ile and Val (3AA), Lys, Thr, Leu, Ile, Val (5AA)	Glc	12 (6M/6F) healthy, BMI = 22.4	2 h	iAUC 90 min W and AA5 < control	iAUC 90 min W and AA3 > control
Järvi et al. 1995	Randomized crossover	Breakfast (CHO 53–57 E%) 1 Durum: Low-GI pasta, High-GI 2 Cereal/Bean: Low-GI, High-GI		1: 10 (5M/5F), T2DM, BMI = 26.7 2: 10 (2M/8F) T2DM, BMI = 27.0	4 h	iAUC (120 min): pasta < bread; Cereal/Bean low-GI < high-GI	iAUC (120 min): pasta < bread; Cereal/Bean low-GI < high-GI
Robert and Ismail 2012	Randomized crossover	Breakfast Individual foods (CHO 25 g): rice, pancake, flatbread, noodles Mixed meals (CHO 28–32 g): coconut milk rice, pancake/chicken curry, flat bread/dhal curry, fried noodles/chicken and prawn	Glc	10 (6M/4F), T2DM, BMI 28.1	3 h	iAUC: all foods < control; flatbread > rice, pancake pancake with chicken > pancake
Wheeler et al. 1990	Randomized crossover Double-blind	Breakfast Glc (50 g), HSH5875^1, HSH6075^1	Glc	T2DM, n = 6, BMI 31.7; T1DM, n = 6, BMI 23.2 and nondiabetic (NGT) n = 6, BMI 24.4	5 h	iAUC (5 h): NGT < DM2 and DM1 all meals; HSH-meals < Glc	iAUC (5 h): HSH-meals < Glc for NGT and DM2
d´Emden et al. 1987	Randomized crossover	Breakfast (CHO 50 g) Breads: white (WB), semolina (SB), white spaghetti (WS), whole meal, brown spaghetti (BS)		10 (3M/7F), T2DM, BMI 30.9	3 h	iAUC: WB, SB > WS, BS; WB vs. SB & WS vs. BS ns	iAUC: WB vs. SB, ns; WS < BS
Liljeberg et al. 1992	Randomized crossover	Breakfast (CHO 50 g) Breads: WK, RK, OK, BK, scalded BK (SBK), barley flour (BF)	WB	10 (5M/5F), healthy, BMI normal	3 h	iAUC: WK, RK, BK and SBK < control	iAUC: all kernel bread < control
Panlasigui and Thompson 2006	Randomized crossover	Breakfast (CHO 50 g) intact brown rice, milled brown rice	WB	10 (3M/7F), healthy; 9 (5M/4F), T2DM	3 h	iAUC: both groups milled > intact
Haber et al. 1977	Randomized crossover	Breakfast (CHO 60 g) Apples: quartered/cored, Purée (fiber-disrupted), Juice (fiber-free)		10 (5M/5F), healthy	3 h	iAUC: ns	iAUC: juice > apples IIP: juice > purée > apples
Leclere et al. 1994	Randomized crossover	Breakfast (CHO 60 E%) Glc: HV-GG, LV-GG Pre-gelatinized Starch (S): HV, LV		6 (3M/3F), healthy	3 h	iAUC (90 min): SHV < SLV SLV < Glc-LV	iAUC (90 min): both HV < LV SLV < Glc-LV
Ellis et al. 1991	Randomized crossover	Breakfast (CHO 75 g) WB + GG flour: high (M150), medium (M90), low (M60) MW WB + granulated GG: coarse, medium, fine particle size	WB	17 (14M/3F), healthy, BMI 22.8	2 h		iAUC: control > all test bread products
Golay et al. 1995	Randomized crossover	Breakfast (CHO 52 E%) Standard Formula: soy/milk protein, sunflower/palm oil, maltodextrin/ sucrose; Diabetic Formula: milk protein, rape-seed oil, partially hydrolysed starch/fructose Diabetic Formula: + hydrolyzed GG		6 (3M/3F), T2DM, BMI 30.4	4 h	iAUC: diabetic formula + guar < standard	iAUC: diabetic formula < standard
Pastors et al. 1991	Randomized crossover	Breakfast (CHO 53 E%) preceded by Placebo, Psyllium	Placebo	18 (6M/12F), T2DM	5 h	iAUC: ns	iAUC: Psyllium < Placebo
Rosen et al. 2009	Randomized crossover	Breakfast (CHO 40 g) white WP, ERB, ERP, WGRB, WGRB+LA, WGRP, bran RB	WB	12 (9M/3F), healthy, BMI = 23.1	3 h	iAUC (120 min): control > ERB, ERP, WGRB-LA, WGRP	iAUC (120 min): Control > ERB, ERP, WGRB, WGRB-lac,
Rosén et al. 2011	Randomized crossover	Breakfast (CHO 50 g) ERB, ERB-LA, WGRB, WGRB-LA, boiled RK, boiled WK	WB	10 (5M/5F), healthy, BMI = 22.6	4.5 h	IGP: control > ERB-LA, RK, WK, WGRB, WGRB-LA,	IIP: control > all test products

iAUC, integrated area under the curve; AUC, area under the curve; CHO, carbohydrate; DF, dietary fiber; NP, nonparboiled; TP, traditionally parboiled; PP, pressure parboiled; B, boiled, EA, elevated amylose; HV/LV, high/low viscosity; AA, amino acid; GG, guar gum; LA, lactic acid; WB, white bread, WP, wheat porridge; ERB, endosperm rye bread; ERP, endosperm rye porridge; WGRB, wholegrain rye bread; WGRP, wholegrain rye porridge; RK, rye kernel; WK, wheat kernel; OK, oat kernel; BK, barley kernel; T1DM, type 1 diabetes; T2DM, type 2 diabetes; Glc, glucose; IGP, Incremental Glucose Peak; IIP, Incremental Insulin Peak; HSH, hydrogenated starch hydrolysates; BMI, body mass index (given as mean in kg m⁻²),¹ HSH5875 (maltitol 60%, sorbitol 7% and reduced maltooligosaccharides 33%), HSH 6075 (reduced maltooligosaccharides 78%, sorbitol 14% and maltitol 8%).

Table 2 Dietary fiber and postprandial glycemic control in diabetic individuals

Reference	Design	Fiber type / fiber source	Control	Study subjects	Duration	Glucose (Glc)	Insulin (Ins)
Maki et al. 2009	Randomised crossover DB	Breakfast (CHO 75 g) (HPMC 1, 2, 4 or 8 g	Cellulose	39 (18M/21F), IGT,BMI ≥ 27	2 h	iAUC: HPMC 4 and 8 g < control	iAUC: HPMC 2, 4 and 8 g < control
Kim et al. 2009	Randomized crossover	Breakfast (CHO ∼ 62 g) β-glucan (barley) 0, 2.5, 5, 7.5, 10 g		17 (F); NGT, increased risk for IR, BMI ∼33.2	3 h	10 g < 0, 2.5, 5 g at peak 30 min; AUC, NS	10 g < 0, 2.5, 5, 7.5 g at 30, 60 min; AUC: 10 g < 0, 5 g (LR)
Jenkins et al. 2008	Randomized controlled SB	Breakfast (Biscuits, CHO 50 g) PolyGlycopleX (PGX) 70% glucomannan, 30% xanthan 10 g	Control (0 g)	9 (3M/6F),T2DM, BMI 28.8	3 h	PGX < control 30, 60, 90, 120, 150, 180 min	—
Nazare et al. 2009	Randomised crossover SB	Breakfast (CHO ∼ 72 g) β-glucan (oats) 5 g	Control (0 g)	12 (M), BMI 27.5, fast ing insulin 49	6 h	AUC (120–360 min): 5 g > 0 g	AUC: (120–360 min), 5 g > 0 g
Chearskul et al. 2007	Crossover controlled SB	Purified glucomannan 1 g with 200 mL water 30 min before 75 g oral Glc	White Rice Flour (1g)	20 (10M/10F), T2DM, BMI (M 25.1, F 27.4)	2 h	Glc increase, glucomannan < placebo 1 to 2 h	Ins: NS
Flammang et al. 2006	Randomised, crossover DB	Breakfast (crispy bar, CHO 50 g) GG 8.4 g	Control 1) DF 0 g 2) DF < 5 g	60 (41M/9F), T2DM, BMI 30.2,	4 h	30, 45, 60, 90, 120 min: GG < control; 240 min: GG > control (1 only); AUC: GG < control	30, 45, 60, 90, 120, 180 min GG < control Min; AUC : GG < Control
Tapola et al. 2005	Randomized controlled	Breakfast 1) OBF, CHO 12.5 g, DF 19.5 g (β-glucan 9.4 g); OBC CHO 12.5 g, DF 6.3 g (β-glucan 3.0 g); 2) CHO 6.1 g, DF 9.5 g (β-glucan 4.6 g)	Glc	12 (7M/ 5F), T2DM	2 h	1) OBF/OBC < gluc (15, 30, 45 min) OBF/OBC > Glc (90 min); AUC (0–60 min, 0–120 min): OBF < Glc; AUC (0–60 min): OBC < Glc; 2) OBF < Glc at 30, 45, 60 min; OBF > Glc at 120 min; AUC (0–60 min, 0–120 min): OBF < Glc
Rendell et al. 2005	Crossover DB	Breakfast prowash barley meal (CHO 20 g, DF 23 g, soluble 10 g); oatmeal (CHO 44 g, DF 7 g, soluble 3 g); LMR (CHO 35 g)	LMR	18 (12M/6F), T2DM, BMI 33	3 h	Prowash < oatmeal, replacer at 30, 60 min iAUC: prowash < oatmeal, replacer	Prowash < oatmeal, replacer at 30, 60 min iAUC: prowash < oatmeal, replacer
Jenkins et al. 2002	Randomized crossover Open-label	Breakfast (CHO 50 g) WB (DF 2.6 g); oat bran cereal (DF 10.3 g, 3.7 g β-glucan); high β-glucan cereal (14.9 g, 7.3 g β-glucan); - high β-glucan bar (DF 17.7 g, β-glucan 6.2 g)	WB	16 (10M/6F), T2DM, BMI 29	3 h	high β-glucan cereal, bar < WB, oat bran at 60, 90, 120 min; AUC, high β-glucan cereal, bar < WB, oat bran	—
Tappy t al. 1996		Breakfast cereals (CHO 35 g) β-glucan 4.0, 6.0, 8.4 g	Continental Breakfast	8, T2DM		Glc increase, 8.4, 6.0, 4.0 g β-glucan < control AUC: linear inverse β-glucan	Ins increase 8.4, 6.0, 4.0 g β-glucan < control
Guévin et al. 1996		Breakfast (DF 10 g and 20 g) soluble:insoluble ratios1:4 vs. 2:3		8, T2DM/ hyper-`triglyceridemic	4 h	iAUC: 20 g < 10 g soluble insol ratio, NS	iAUC: 20 g < 10 g soluble insol ratio, NS
Gatenby et al. 1996	Randomized crossover	Breakfast (CHO 75 g) GG (low, med., high MWt) 7.6 g GG/ meal	Control Meal	14, T2DM		Glc increase, GG < control	Ins increase, GG < control
Braaten et al. 1994		Porridge meals (Farina); isolated β-glucan, oat gum; - native β-glucan, oat bran; farina meal	Farina Meal	T2DM	3 h	oat bran, gum < control	oat bran, gum < control
Sels et al. 1992		Spaghetti meal (CHO 51%); - T. aestivum; T. durum wheat with/without 20 g% GG		6, T2DM		iAUC: GG vs. no GG, ns IGP lower at 60 and 90 min after GG T. aestivum
Librenti et al. 1992	Randomized cross-over	Breakfast soya fiber 7 g; purified cellulose 7 g - ingested before standard breakfast		8, T2DM		Glycemic profiles, soya < cellulose AUC: soya fiber < cellulose	Ins profile, ns
Pastors et al. 1991	Randomized crossover controlled	Breakfast (CHO 73 g) psyllium 6.8 g (in 240 mL of water) vs. placebo before breakfast	Placebo	18 (6 M/12 F),T2DM, overweight/ obese	5 h	psyllium < placebo up to 90 min; AUC, ns	psyllium < placebo up to 90 min; AUC, psyllium < placebo
Torsdottir et al. 1991	Randomized crossover	Breakfast (CHO 48%) meals with/ without sodium alginate 5.0 g (algae-isolate, 75% soluble)	Fiber-free meal	7(M), T2DM, BMI 25.6		alginate < fiber-free at 105 min	alginate < fiber-free at 15, 60, 90 min
Del Toma et al. 1988	Randomized crossover	low fiber (LF); high soluble fiber (HSF); high insoluble fiber (HIF)		10, T2DM		HSF < LF, HIF LF vs. HIF, NS	HSF < LF, HIF LF vs. HIF, NS
Del Toma et al. 1988	Randomized crossover	Lunch (CHO 45%) LF (6.7 g, sol. 2.0 g); HF (32.9 g, sol. 14.3 g)		13 (8 M/5F), T2DM, BMI 27	3 h	HF < LF at 30, 45, 60, 90 min	HF vs. LF, NS
Tsai et al. 1987	Randomized crossover	Breakfast, (CHO 48.5%) noodles with/without soy 10 g	Fiber-free Meal	7 (3 M/4F), T2DM/ obese	4 h	Soy < fiber-free at 180, 240 min	Soy vs. fiber-free, NS
McIvor et al. 1985		Breakfast high-CHO HF (HCF) bar consumed alone or with meals	Placebo Bar absorbable CHO and GG	20, T2DM		HCF < placebo (early PP period); bars with HCF < placebo (90 to 240 min)
Hagander et al. 1984		Breakfast HF and LF		8, T2DM	3 h	Glc increase/decrease, HF < LF; iAUC: HF < LF
Jenkins et al. 1976	Randomized crossover	Test meals, CHO 106 g; control; control + GG 16 g, pectin 10 g		1) 8, T2DM (non-insulin-requiring) 2) 3, T2DM (insulin-dependent)		1) Glc decrease, GG + pectin > control from 30 to 90 min 2) Glc decrease, GG+pectin > control	1) Ins decrease, GG+pectin > control from 30 to 120 min
Weickert et al. 2005	Randomised crossover SB	Insoluble cereal fiber extracts from oat and wheat, and resistant starch, baked in white bread	WB	14F, healthy	24 h	Reduced AUC glucose in a second meal test in all interventions vs. control	ns difference between diets, trend to lower AUC insulin
Weickert et al. 2006	Randomised crossover SB	Insoluble cereal fiber extract from oat, baked in white bread	WB	17F, overweight /obese	72 h		Improved whole-body IS vs. control, EHC
Weickert et al. 2011a, 2011b (1)	Randomised crossover SB	HCF diet supported by twice daily supplements	Healthy (ADA) HP MF/ Protein + supplements	111, overweight / obese/ metabolic syndrome	18 wks		Improved whole-body IS vs. HP, EHC NS IS (HOMA-IR)
Robertson et al. 2003	Randomised crossover	RS	Waxy Maize Starch	10, healthy	24 h		Estimated IS (SI oral); iAUC C-eptide/insulin
Robertson et al. 2005	Randomised crossover	RS	Rapidly digestible starch	10, healthy	4 wks		Increased IS using EHC
Johnston et al. 2010	Randomised parallel SB	RS	Rapidly digestible starch	20, healthy	12 wks		Increased IS using EHC
Nilsson et al. 2008	Randomised crossover	Barley or kernel breakfast	WB	12, healthy	1 d	Improved iAUC glucose	Improved iAUC insulin
Pereira et al. 2002	Randomised crossover	Diet containing whole grains	Refined Grain Diet	11 overweight/ obese hyper-insulinemic adults	6 wks		Improved whole-body IS vs.refined grain diet, EHC
Chandalia et al. 2000	Randomized crossover	HF diet (24 vs 50 g/d) oats, lima beans, sweet potatoes), no supplements	Healthy (ADA)	17 (16M/1F), T2DM, 45–70 y	6 wks	improved glycemic control (plasma glucose, urinary glucose, HbA1c)	decreased hyper-insulinemia (plasma insulin)
Jenkins et al. 2008	Randomized parallel	HCF diet (27–32 g/d vs. 25–27 g/d) whole grain bread, brown rice, whole wheat cereals	Low GI	210 (128M/82F), T2DM, 60 y, BMI 31	6 m	HbA1c reduced in low GI vs. HCF
Wolever et al. 2008	Randomized parallel	Low GI vs. low CHO (21 vs. 36 vs. 23 g/d) branbuds cereals, rye pumpernickel bread, beans	High GI	162, T2DM, 35–75 y, BMI 24–40	1 y	HbA1c NS DF PPG reduced (low GI diet)
Sorensen and Johansen 2010	Randomized crossover	FOS dissolved in water 20 g/d (31–40 g/d from the diet)		12 (6M/6F), IRH, 41–75 y, BMI 20–29	2 wks	supplemental dietary fiber reduced glucose excursions in IRH
de Natale et al. 2009	Randomized crossover	HCF diet (53 vs. 15 g/d) whole grain cereals legumes, veg.	LC-high MUFA Diet	18 (12M/6F), 59 y, T2DM, BMI 27	4 wks	PPG reduced	PP insulin response reduced
Schwab et al 2006	Randomized parallel	Sugar beet pectin +16 g/d (24–30 g/d fiber from the diet)	PDX Drink	66 (29M/37F), T2DM 10 IGT, IFG, 53 y, BMI 28	12 wks	ns fasting glucose

DB, double blind, SB, single blind; HPMC, hydroxypropylmethylcellulose; EHC, euglycemic hyperinsulinemic clamp; IS, insulin sensitivity; HOMA-IR, homeostasis model assessment for insulin resistance; LMR, liquid meal replacer; IFG impaired fasting glucose; IGT, impaired glucose tolerance; IRH, idiopathic reactive hypoglycemia; NGT normal glucose tolerance; LR, linear response, OBF, oat bran flower; OBC, oat bran crisp; L(H)F, low (high) fiber, L(H)IF, low (high) insoluble fiber, L(H)SF, low (high) soluble fiber, MF, moderate fiber; HP, high protein; iAUC, integrated area under the curve; AUC, area under the curve; CHO, carbohydrate; DF, dietary fiber; RS, resistant starch; GG, guar gum; WB, white bread; NS, no significant effect; T2DM, type 2 diabetes; Glc, glucose; IGP, Incremental Glucose Peak; IIP, Incremental Insulin Peak; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified).

Table 3 Non digestible carbohydrates with prebiotic properties on blood parameters related to glucose homeostasis

Reference	Design	Subjects	Source	Control	Duration	Outcome measures	Outcome
Lu et al. 2004	Randomized crossover	15 (9F/6M), T2DM, 60 ± 2 y, BMI 28.1 ± 0.9	Bread/Muffins with arabinoxylan (14%) 15.1 g/d arabinoxylan	arabinoxylan 0%	6 wks	fasting and 2h Glc, insulin, urinary Glc HbA1c, plasma insulin	decrease in fasting glycemia, decrease in post-OGTT glycemia&insulinemia
Garcia et al. 2006	Randomized crossover SB	11 (7F/4M), IGT, 60 y; BMI 31	WB supplemented with arabinoxylan (15 g) 15 g/d	WB	6 wks	fasting serum Glc, insulin	fasting serum glucose was significantly lower than placebo
Garcia et al. 2007	Randomized crossover SB	11 (7F/4M), IGT, 55.5 y, BMI 30.1	WB supplemented with arabinoxylan (15 g) 21 vs. 36 vs. 23 g/d	WB	6 wks	PPG and PPI	lower postprandial responses in serum glucose and insulin after a liquid meal challenge test in supplemented group
Parnell and Reimer 2009	Randomized crossover DB Placebo-controlled	48 overweight/ obese, 20–70 y, BMI >25	Supplement 21 g/d oligofructose	Maltodextran	12 wks	Serum Glc and insulin	decrease in body weight, decrease in caloric intake, increase GIP ns fasting glucose, insulin, GLP-1 PYY, leptin After MTT decreased glycemia, decreased insulin, increased AUC for PYY, ns AUC for GLP-1, ns GIP
Luo et al. 2000	Crossover DB	10 94F/6M) T2DM	Short-chain fructans 20 g/d with coffee, tea or yogurt	Sucrose 20 g/d	4 wks	fasting Glc, fasting insulin, ITT	NS for caloric intake, body weight, glucose, insulin, hepatic glucose production, insulin-stimulated glucose metabolism
Daubioul et al. 2005	Randomized crossover DB	7M overweight with nonalcoholic steatohepatitis37–66 y, BMI 29	Oligofructose16 g/d with breakfast and dinner	Maltodextran	8 wks	fasting Glc, fasting insulin	decrease in fasting insulin, NS for fasting glycemia

DB, double blind; SB, single blind; T2DM, type 2 diabetes; Glc, glucose; PPG postprandial glycemia; PPI, postprandial insulinaemia; WB, white bread, NS, nonsignificant change, BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified).

Table 4 Dietary fatty acids and postprandial glycemic control

Reference	Design	Subjects	Source	Daily Intake	Duration	Outcome measures	Outcome
Scalfi et al. 1991	Randomized crossover	6 Lean: 28 ± 1.5 y, BMI 23.1 ± 0.7; 6 Obese: BMI 35.1 ± 3.7, 47.1 y, Italy	FA length: MCT oil C6:0 2%, C8:0 56%, Cl0:0 40%, and C12 2% est.with glycerol LCT = corn oil	Test Meal: 15% protein, 58 g; 55% CHO, 194 g; and 30% fat, 38g	6 h	iAUC, indirect calorimetric for RMR, glucose oxidase method and immunoassay for insulin	resting metabolic rate decreased when LCT were replaced by MCT; incremental Glc AUC lower in lean but not obese subjects after MCT, NS for chain length on insulin or free fatty acids
Zambon et al. 1992	Randomized crossover	10M, T2DM; 64±2 y; BMI 28.6±1, USA	n-3 capsules	8 g/d	8 wks	iAUC plasma Glc and insulin	decreased IR to meal with fish oils in presence of glyburide compared to drug alone. NS for HDL and triglycerides
Lerman-Garber et al. 1994	Randomized crossover	12F, T2DM, Mexico	Avocados high source of MUFA	n/a	4 wks	blood samples pre- and post	glycemic control was similar with both diets. MUFA diet was associated with a greater decrement in plasma triglycerides (20 vs. 7% in the high CHO diet).
Rivellese et al. 1996	Placebo DB parallel	16, T2DM, 35–75 y, BMI 24–40, Italy	Fish oil supplements EPA/DHA	2.7 g/d for 2 m then 1.7 g/d for 4 m	6 m	euglycemichyper-insulinemic clamp	NS for fish oil on insulin stimulated Glc uptake. reduction in TG but not Glc after intervention.
Christiansen et al. 1997	Randomized crossover	16 (7 post-menopausal F/9M), free-living obese T2DM, 55 ± 3y BMI 33.5±1.2, Denmark	Saturated FA diet, cis-MUFA diet, trans-MUFA diet	20 g/d (31–40 g/d from the diet)	6 wks	incremental serum insulin, fasting and 2h plasma Glc, insulin and C-peptide	decreased serum insulin and C-peptide following cis-MUFA (NS for control) compared with trans-MUFA and saturated FA diets. NS for fasting levels of serum lipids (total cholesterol, TG, phospholipid, and nonesterified fatty acids) or lipoproteins of HDL, VLDL, LDL and apolipoprotein B
McCargar et al. 1998	Randomized prospective	32 T2DM Canada	CHO and Fat Ensure with Fat or Glucerna	n/a	4 wks	PPG	PP rise in blood Glc was lower on MUFA diet. NS for fasting plasma Glc, fructosamine, TG and cholesterol levels
Madigan et al. 2000	Randomized crossover	11M T2DM, HbA1c 5.7 ± 0.8%, 56.0 ± 2.5 y, Ireland	isocaloric diet, high MUFA (olive) or PUFA (sunflower). Meal: High-fat breakfast, 50 g Glc load (30 min). WB fried in oil 1,100 kcal, 55% fat	30 mL/daily	8 h	Fasting Glc and Insulin	plasma cholesterol, LDL, chylomicron Apo B48 & Apo B100, PP chylomicron, VLDL Apo B48 & B100 higher on the linoleic acid diet. Fasting Glc/ insulin higher after PUFA compared to MUFA.
Piers et al. 2003	Randomized crossover	8M, obese/ overweight	Total E from SFA, MUFA & PUFA 24, 13 and 3% on SFA diet; 11, 22 and 7% on MUFA diet. In selected foods.	4 wks	5 h	Fasting Glc and Insulin	lower weight −2.1 ±0.3 kg & fat mass −2.6 ± 0.6 kg on MUFA vs. SFA rich diet. Blood Glc −0.04 + 0.6 mM (SFA) &−0.15 + 0.53mM (MUFA); insulin +0.2 + 3.68 (SFA) & −0.66 + 2.44 (MUFA)
Thomsen et al. 2003	Randomized crossover	12, T2DM, overweight, 64 ± 4 y, BMI 27.9 ± 5.3, HbA1c 6.9± 0.8%, Denmark	Control: Soup CHO 50 g, Control + 100 g butter, Control + 80 g olive oil		8 h	iAUC	iAUC: lower for olive oil vs. control, NS for fat-induced insulin, plasma TG and chylomicron TG highest after butter, HDL decreased after butter but NS after olive oil. GLP-1 responses highest after olive oil
Brady et al. 2004	Randomised parallel DB	29, T2DM, 48 +2 y; BMI = 26 Fasting Glc = 5.3 mM, Asian UK	Moderate (olive oil) or high (corn oil) n–6 PUFA oils. Test breakfast : energy (3904 kJ), fat (49 g) CHO (109 g) protein (18 g)	6 wk daily supplement of n–3 LC-PUFA fish oil (4.0 g); EPA + DHA (2.5 g) in combination	8 h	iAUC	NS for fasting or PP plasma triacyl-glycerol or apo B48 for moderate and high intervention groups after fish-oil treatment. Over entire study period: reduction in fasting plasma TG (20%). AUC and iAUC: reduction in PP TG
Manning et al. 2004	Randomized crossover	18, T2DM (2 -60 m) nonsmokers, 61 ± 10 y, BMI 28.5 ± 4.4 fGlc 6.8 ± 1.7 mmol/l, HbA1c 6.5 ± 0.6%, Canada	meals of starch +/- SFA or MUFA		6 h	FBG mM, insulin pM	NS for PPG and PPI after fatty meals, CHO increased PPG and PPI, FFA and TG increased in fat diets at 4h and 6h. IL-6 decreased after 1h and TNF-α decreased after 4 and 6h in all diets
West et al. 2005	Randomized crossover DB	18, T2DM (duration 4.4 ±1.6 y), HbA1c 7.2%, 55.1+2 y, fGlc = 7.69 ± 0.35 mM, fI = 12 ± 1.5 uU/ml, BMI 29.2, US	Test meal: n-3 PUFA, prepared in 473 mL skimmed milk, flavourings designed to mask the characteristic aroma and flavors of the oils	50 g fat from three blends of unsaturated fatty acids	4 h		correlation between PP change in flow-mediated dilation and PP increase (absolute change) in TG for MUFA alone were as follows: r = –0.50, p < 0.05 for the MUFA meal; r = 0.49, p = 0.052 for the EPA/DHA meal; and r = 0.49, p = 0.046 for the ALA meal. NS for meal composition on Glc levels
Lefevre et al. 2005	Crossover	Overweight, FABP Ala54 homozygous or Thr54 carriers, US	Breakfast: provided 40% of their daily energy requirement and containing 50% of energy as fat		8 h	PPG	NS for PPG between diets but Thr54 allele increased PPG, fractional TG synthesis rates were higher after trans fats in Thr54 carriers only
Paniagua et al. 2007	Prospective crossover	overweight, family history of obesity and T2DM, BMI > 25 Kg/m^2, WC (M/F) > 102/ 88, HBA1c < 6.5%, IR after OGTT, Spain	Breakfast isocaloric : virgin olive oil compared high CHO or high in saturated fat (SAT)		Single meal effect	FBG, Homa-IR, iAUC for insulin and Glc	MUFA decreased fGlc and increased IS, PPI and PPG, iAUC decreased with MUFA vs. isocaloric CHO rich breakfast, GLP-1 increased with MUFA and SAT; HDL cholesterol increased with MUFA (fasting and PP), fasting proinsulin and stimulated proinsulin NS for MUFA diet
Devaraj et al. 2008	Randomized crossover	11 metabolic syndrome, US	Breakfast: AHA vs. SFA. Control: breakfast E 914, protein 14.1%, CHO 36%,fat 50%		2h & 8 h		Glc levels significantly increased compared to pre-meal after both meals i.e. NS
Li et al, 2008	Controlled parallel DB	127, T2DM 40–65 y, China	diacylglycerol (DG) compared to triacylglycerol (TG)	25 g/day oil for 120 d		fasting measurements taken at days 0, 60, 120, No PP study	reduced body weight, BMI, waist circumference, HOMA-IR, serum insulin and leptin levels in DAG vs. TG vs. baseline, serum Glc improved in patients with higher Glc at baseline in the DG, NS for liver/kidney function and FA in serum phospholipids
De Natale et al. 2009	Randomized crossover	18, T2DM, 59 ± 5 y, BMI 27 ±; A1C 6.9 ± 0.7%	isoenergetic diet, low CHO and high MUFA vs. high CHO, High fiber	For 4 wks	6 h	mM, glycemic variability and IAUC	Increased Glc following fiber vs. MUFA diets at 2h & 3 h, increased lipids, triacylglycerols following fiber vs. MUFA diets, NS for cholesterol, plasma Glc & insulin higher 6 h after thigh CHO/high fiber meal vs. high MUFA meal
Sloth et al. 2009	Randomized	131, 8-week weight loss diet, Denmark	High MUFA, low GI MUFA, moderate -fat (35–45 E%) high in MUFA with low GI, low fat (20–30 E%), control (35 E%)		6 m	PPG, PPI	Decreased PPG and PPPI on MUFA or low fat vs. control/western diet, NS for fasting insulin, pancreatic polypeptide, peptide YY, glucagon-like peptide-1 and glucagon-like peptide-2 lowered after weight loss diet
Li et al. 2011	Randomized crossover	20 (9M,11F) T2DM, China 58 years, BMI = 26kg/m2	fiber, MUFA and PUFA in almonds	NCEP step II diet with or without 60 g almonds	12 wks	fI, fBG, IR	almond diet had lower levels of fasting Glc, insulin and homeostasis model assessment of insulin resistance index, respectively, decreased total cholesterol, LDL, LDL/HDL
Lopez et al. 2011	Crossover		MUFA vs. SFA vs. no fat in enriched meals. Test meal no fat isocaloric meal	14.9% SFA, 81.0% MUFA, 4.1% PUFA (olive oil);65.3% SFA, 31.3% MUFA, and 3.4% PUFA (butter)	8 h	PPI	high-fat meals significantly increased TG, nonesterified fatty acids, and insulin and PP indexes of β cell function. However, PP indexes of IS decreased and were sattenuated with MUFA relative to SFA
Jans et al. 2012	Randomized crossover SB	10M obese (IR), Holland	PUFA vs. MUFA vs. SFA, 3 high-fat mixed meals (2.6 MJ), which were high in SFAs, MUFA, or PUFA	2.6MJ high fat mixed meal	6 h	Fasting and PP skeletal muscle FA, skeletal muscle biopsy, AUC	AUC (Glc and insulin): significantly higher for SFA vs. PUFA, TG-derived FAs lower in the PP phase after PUFA meal c.f. other meals, fractional synthetic rate of the TG, DG, and phospholipid pool was higher after the MUFA meal vs. SFA
Kelley et al. 2012	Placebo-controlled parallel	14–17M hyper-triglyceridemic	DHA without EPA vs. control	3 g/d vs. 0 g/d supplement	90 d	Fasting plasma Glc and insulin, PPG, PPI, AUC Matsuda index	increased fasting plasma Glc with DHA. NS for indices of fasting IR, PPI and PPG. AUC: NS increased Glc in placebo (2.7%). NS for both groups. DHA decreased several lipocentric markers of IR, including circulating non-esterified fatty acids, small, dense LDL particles and TG/ HDL ratio, NS for placebo

DB, double blind; NS, no significant effect; IR, insulin response; T2DM, type 2 diabetes; AUC, area under the curve; CHO, carbohydrate; F, female; M, male; FA, fatty acid; PUFA, polyunsaturated fatty acid; MUFA, monounsaturated fatty acid; SFA, saturated fatty acid; Glc, glucose; fGlc, fasting glucose, WC, waist circumference; IR, insulin resistant; IS, insulin sensitivity; TG, triglycerides; HDL, high-density lipoprotein; VLDL very low-density lipoprotein; LDL, low-density lipoprotein; PPG postprandial glycemia; RMR, resting metabolic rate; PPI, postprandial insulinaemia; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified).

Table 5 Dietary vitamins and minerals and postprandial control

Reference	Design	Subjects	Source	Daily intake	Duration	Outcome measures	Outcome
Neri et al. 2005	Controlled SB	46, T2DM, 41±3 y, BMI 24±2,USA	Vitamin E, vitamin C and N-acetyl cysteine	8 g/d	8 wks	iAUC plasma Glc and insulin	Only measured at baseline
Frauchiger et al. 2004	Randomized crossover SB	13M, healthy, nonsmoking, 23.8–25.6y, BMI 22–23	Test meals (75g CHO) WB with added chromium	Placebo vs. 400 μg vs. 800 μg	8 h	Glc tolerance test, AUC plasma insulin	30%–36% reduction in capillary Glc AUC with 400 μg Cr in10 responders
Anderson et al. 1997	Randomized crossover DB	180 (M/F), T2DM	Normal diet supplemented with chromium picolinate	Placebo vs. 200 μg/d vs. 1000 μg/d	4 m	HbA1c fasting Glc and insulin; 2 h Glc and insulin	HbA1c, fasting, 2 h Glc and insulin significantly reduced in patients supplemented with Cr for 4 months
Cheng et al. 1999	Follow-up survey	833, T2DM	Supplementation (500 μg/d) with chromium picolinate	500 μg/d	10 m	fasting and PPG	fasting Glc and PPG improved in >90% of subjects, and similar improvements occurred after 1–10 months. Fasting Glc level and PPG lowered in 1 month and remained significantly lower in the following 9 months.

DB, double blind; SB, single blind; Cr, chromium; NS, no significant effect; IR, insulin response; WB, white bread; T2DM, type 2 diabetes; Glc, glucose; HDL, high-density lipoprotein; PPG postprandial glycemia; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified).

Table 6 Effect of phytochemical rich sources (cocoa, plant extracts) on postprandial glycemia

Reference	Design	Subjects	Source	Daily intake	Duration	Outcome measures	Outcome
Grassi et al. 2008	Randomized crossover DB	19 (11M/8F), IGT (no diabetes), 44.8±8.0 y, BMI < 30	Dark chocolate bar (epicatechin, catechin, procyanidin) Control: WC	100 g/d	15 d	OGTT, AUC, lipids, CRP, endothelial function	decreased HOMA, increased QUICKI, PPG (p < 0.0001)
Grassi et al. 2005	Randomized crossover DB	15 (7M/8F), healthy, 44.8±8.0 y	Dark chocolate bar (epicatechin, catechin, procyanidin) Control: WC	100 g/d	15 d	OGTT, AUC,lipids, CRP, endothelial function	decreased HOMA, increased QUICKI, PPG (p < 0.0001)
Muniyappa et al. 2008	Randomized crossover DB	20 (7M/13F), 13 White, 7 African Americans, mild-moderate hyper-tension 21–65 y	Flavanol-rich cocoa drink (epicatechin, catechin, procyanidin)	300 mL/d contains ∼900 mg flavanols/d	2 wks	Glc clamp, metabolites, endothelial function, BP	NS for IR
Kar et al. 2009	Randomized crossover DB	32 (16M/16F), T2DM, 61.8±6.36 y, BMI 31.2±5.92	Grape seed extract (flavonoids, other phenolics)	600 mg/d	4 wks	HOMA-IR, fructosamine endothelial function, CRP	decreased fructosamine, NS for HOMA-IR
Serraclara et al. 1998	Randomized crossover DB	10 (6M/4F), IDMM, 22–38 y BMI 20.8±3.0	Fig supplement (flavonoids, other phenolics) Control: non-sweet commercial tea control	53 vs. 15 g/d	1 m	2h PP lipids	decreased plasma Glc
Lehtonen et al. 2010	Randomized parallel	10, healthy, 20–34 y, BMI 19.8–26.9	Sea buckthorn extract in yogurt (flavanol glycosides)		6 h	OGTT, AUC	decreased plasma Glc/insulin
Torronen et al. 2010	Randomized crossover	12 (2M/10F), Healthy, 25–69 y BMI 25.4 ± 2.9	Berry puree (flavonoid, other phenolics) Control: carbohydrate drink	150 g	3 h	15, 30 min plasma Glc	decreased plasma Glc
Goni et al. 2000	Crossover	12F, healthy, 22.08 ± 1.44 y, BMI 2.19 ± 2.78	Nori alga with WB	3 g	2 h	OGTT, AUC	Decrease in PPG
Markey et al. 2011	Randomized crossover SB	9 (3M/6F), healthy, 26.2 ± 3 y, BMI 22.4 ± 2.5	High-fat meal supplemented with cinnamon or placebo	3 g	360 min	OGTT, AUC Arterial stiffness, BP	NS for PPG

DB, double blind; SB, single blind; WC white chocolate; NS, no significant effect; IR, insulin response; WB, white bread; T2DM, type 2 diabetes; Glc, glucose; HDL, high-density lipoprotein; PPG postprandial glycemia; IGT, impaired glucose tolerance; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified) iAUC, integrated area under the curve; AUC, area under the curve; CHO, carbohydrate; DF, dietary fiber; OGTT, oral glucose tolerance test; HOMA-IR, homeostasis model assessment for insulin resistance; CRP c-reactive protein.

Table 7 Effect of ginseng on postprandial glycemia

Reference	Design	Subjects	Source	Daily intake	Duration	Outcome measures	Outcome
Sievenpiper et al. 2003a	Randomized controlled crossover	11 (8M/3F), 29 ± 3 y, BMI 28.5 ± 2.1; 11 (6M/5F), 27 ± 3 y, BMI 26.9 ± 1.4	Asian Ginseng	1) 0, 1, 2, 3 g; 2) 0, 3, 6, 9 g	120 min	OGTT	decreases in PPG American c.f. Asian
Sievenpiper et al. 2003b	Randomized, crossover SB	12 (6M/6F), 31±3 y, BMI 28±2	American Ginseng	6 g	120 min	OGTT, iAUC	NS for AG on iAUC Glc
Sievenpiper et al. 2004	Randomized, multiple- crossover DB	12 (6M/6F), healthy, 34 ±3 y, BMI 25.8± 1.2, Canadian	American, American-wild, Asian, Asian-red, Siberian, Vietnamese-wild, Sanchi and Japanese-rhizome, Ginsengs (alkaloids, ginsenosides)	3 g	120 min	OGTT	American Ginseng and Vietnamese Ginseng decreased 90 min PPG; Asian Ginseng increased peak-PPG and AUC-PG; American-wild Ginseng increased 120 min PPG and Siberian Ginseng increased 90 min PPG, 120-min-PG, and AUC-PG.
Sievenpiper et al. 2006	Randomized crossover DB	7 (3M/4F), healthy, 32 ± 4 y, BMI 24 ± 2; 12 (9M/3F), healthy, 29 ± 3 y, BMI 22.5 ± 1	Korean Ginseng (ginsenosides, alkaloids)	0 g (placebo) and 6 g KRG-rootlets, -body, and -H2O extract	120 min	OGTT, AUC	decrease in PPG
Dascalu et al. 2007	Randomized crossover placebo controlled	12 (5M/7F), healthy, 26.5 ± 2 y, BMI 23.96 ±3.41, Canadian	American ginseng (5 farms), whole, dried and ground root	9 g, 40 min before 75 g OGTT, placebo 500 mL water	2 h	OGTT	1 mM reduction peak Glc, 28% reduction iAUC, 24% reduction iAUC insulin. NS for 2 batches
Reay et al 2006	Balanced-crossover DB placebo-controlled,	1) 30 healthy, BMI 22.6 ± 5.46, 2) 27 healthy, BMI 1.89 ± 4.46, UK	Asian Panax Ginseng Extract (G115)	1) placebo, 200 or 400 mg 2) placebo, 200 mg placebo and Glc (25 g) and 200 mg 30 mins before and Glc (25 g)	2h	OGTT	1) decreased Glc at 60, 90,120 mins 2) decreased Glc at 60 min for ginseng vs placebo. Higher Glcfor ginseng and glucose compared to glucose alone.
Reay et al. 2009	Cross-over DB placebo-controlled,	1) 24 healthy, BMI 33.3 ± 10.4 2)18 healthy, BMI 41.5 ± 9.7, UK	1) Asian Panax Ginseng Extract (G115); 2) Asian Panax ginseng extract Cheong Kwan Jang	200 mg/d	57 d	HbA1c, plasma insulin, blood Glc	Ns for HbA1c
Sotaniemi et al. 1995	DB placebo-controlled	36 T2DM, 60 ± 6 y, 59 ± 7 y, 57 ± 9 y, Finland	Ginseng	100 mg or 200 mg	8 wks	Fasting blood Glc, HbA1c	100 mg decreased fasting Glc 8.3 to 7.7 (p < 0.05), 200 mg reduced HbA1c from 6.5 to 6.0 (p < 0.05). NS for Glc, insulin, C-peptide over OGGT (75 g)
							Reduction in HbA1c
Vuksan et al. 2000	Randomized crossover placebo controlled	10 (6M/4F), nondiabetic 41 ± 13 y, BMI 24.8 ± 3.5	American Ginseng, ground root, encapsulated (500 mg)	0, 3, 6 or 9 g	120 min	OGTT, AUC	All AG doses reduced AUC and IIG (3g, 26.6%; 6g, 29.3%; 9g, 38.5%). AG taken at different times did not influence PPG
Vuksan et al. 2000	Randomized crossover SB placebo controlled	10 (6M/4F), T2DM, 63±-2 y, BMI 27.7±-1.5, Canadian	American Ginseng encapsulated, ground root (500 mg)	0, 3, 6, or 9 g	120 min	OGTT, AUC	3,6 or 9 g significantly reduced iAUC (19.7, 15.3 and 15.9%). NS for time of administration
Vuksan et al. 2000	Randomised crossover placebo controlled	1) 9 T2DM, 62 ± 7 y, BMI 29 ± 5 2) 10 healthy, 34 ± 7 y, BMI 25.6 ± 3	American ginseng	3 g	120 min	OGTT	1) reduction (19%) in iAUC 40 minutes before the Glc challenge, reduction (22%, p < 0.05) when given glucose; 2) reduction (18%) in iAUC 40 minutes before the Glc challenge, NS when given together.
Vuksan et al. 2001	Randomized crossover DB	10 (6M/4F), IDMM, 63 ± 2 y, BMI 27.7 ± 1.5	American Ginseng, Ontario-grown ground root encapsulated	0, 3, 6, or 9 g	120 min	OGTT	decreased PPG
Vuksan et al. 2001	Randomized crossover SB placebo controlled,	12 healthy, 42 ±7 y, BMI 24.1 ± 1.1, Canadian	American Ginseng, dried and ground root encapsulated (500 mg)	0, 1, 2, or 3 g	120 min	OGTT	Decreased PPG (final 45 min) 1, 2, or 3 g ginseng c.f. placebo; deceased AUC (final hour) when administered 40 min c.f. 20, 10, or 0 min before the challenge
Vuksan et al. 2006	Randomized crossover SB	19 (11M/8F), well-controlled T2DM, 64±2 y, BMI 28.9±1.4	Korean Red Ginseng, root with meal (ginsenosides alkaloids)	2 g/meal = 6 g/day	12 wks	OGTT, AUC	decrease in PPG
De Souza et al. 2011	Randomized crossover	13 (6M/7F), healthy, 28 ± 10 y, BMI 24.1 ± 3	Korean Red Ginseng with standard meal (ginsenosides alkaloids)	3 g of KRG-body, rootlets or placebo	120 min	OGTT, AUC	27% decrease in glycemic response
Heacock et al. 2008	Randomized crossover	39 (15M/24F), healthy, 25.7 ± 0.9 y, BMI 23.7 ± 0.4	Beverage 480 mL (14 g fat, 82 g, CHO 20 g protein) with S. oblonga extract (salacinolkotalanol)	0, 500, 700, or 1000 mg of S. oblonga extract	2 h	Finger prick	decrease in PPG/PPI
Collene et al. 2005	Randomized crossover	43 (20M/23F), healthy, 23.5±0.6 y, BMI 23.9 ± 0.4, 29 Caucasian, 1 African American, 8 Asian, 1 Latino	Control Beverage (C) 480 mL (14 g fat, 82 g CHO, 20 g protein), C plus phenylalanine and leucine (3.5 g, A); C plus S. oblonga extract (1000 mg, S), Control plus S and AA	1000 mg of S. oblonga extract	3 h	OGTT, AUC	decrease in PPG
Williams et al. 2007	Randomized crossover DB	66 (53M/13F), T2DM, 61.3 ± 1.2 y, BMI 28.8± 0.4, 1 American India/Alaskan, 7 African American, 58 Caucasian	S. oblonga extract	240 mg and 480 mg	3 h	OGTT, AUC	decrease in PPG/PPI

DB, double blind; SB, single blind; IDMM, insulin-dependent diabetes mellitus NS, no significant effect; IR, insulin response; WB, white bread; T2DM, type 2 diabetes; Glc, glucose; HDL, high-density lipoprotein; PPG postprandial glycemia; IGT, impaired glucose tolerance; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified) iAUC, integrated area under the curve; AUC, area under the curve; CHO, carbohydrate; DF, dietary fiber; OGTT, oral glucose tolerance test; HOMA-IR, homeostasis model assessment for insulin resistance; CRP c-reactive protein.

Table 8 Effect of phytochemical rich sources (nuts and beverages) on postprandial glycemia

Reference	Design	Subjects	Source	Daily intake	Duration	Outcome measures	Outcome
Josse et al. 2007		9 (7M/2F), healthy, 27.8 ± 6.9 y BMI 22.9 ± 3.6	50 g CHO from white bread +/- almonds phenolics, flavonoids, sterols	30, 60, 90 g almonds	120 min	OGTT, AUC	decreased PPG, lower serum cholesterol
Cohen and Johnston 2011	Randomized crossover	1) 13 (2M/11F), healthy, 53.3 ± 3 y;2) 7 (4M/3F), T2DM, 66.3 ± 3 y	test meal (bagel, juice, and butter) with or without almonds phenolics, flavonoids, sterols	28 g/d	120 min	OGTT, AUC	decreased PPG compared to T2DM; NS for iAUC insulin or 30 min GLP-1
Cohen and Johnston 2011	Randomized parallel, pilot	13 T2DM, 66 ± 3.3 years, BMI 32.6 ± 2.3 Control BMI 36.7 ± 3.6	Almonds Control: cheese sticks	1 oz, 5 d/week	acute	HbA1c on fasting venous blood	HbA1c: –4% vs. +1%, p = 0.045 to T2DM
Kendall et al. 2011a, 2011b	Randomized crossover	10, healthy, 48.3 ± 6.4 years, BMI: 28 ± 4.8	Pistachio consumed with/without WB (50 g CHO)	28, 56 or 84 g	120 min		lower relative glyceamic response vs. WB
Mori et al. 2011	Randomized crossover	14 IGT, 18–60y	75 g CHO matched breakfast (orange juice and cream of wheat) containing vehicle, whole almonds, almond butter, defatted almond flour or almond oil phenolics, flavonoids, sterols	42.5 g	acute	OGTT, AUC	decreased PPG
Jenkins et al. 2006	Crossover	15 healthy, 26.3 ± 8.6 years, BMI 23.4 ± 3.4	WB (50 g CHO), WB and 60 g almonds, parboiled rice and mashed potatoes, these last 2 were balanced for fat (butter), protein (cheese)	60 g	240 min	iAUC	insulin iAUC lower for almond and rice compared to potato.
Kendall et al. 2011a, 2011b	Randomized crossover	14 healthy, 36 ± 4 y, BMI: 21.8 + 0.6) 10 T2DM 68 ± 2 years, BMI: 26.5 ±0.5	WB (50 g CHO) with or without 30, 60, 90 g mixed nuts	30, 60, 90 g	120 mins		1) 30, 60, 90 g reduced the GR by 11.2 + 11.6%, 29.7 + 12.2 and 53.5 + 8.5%; 2) 30, 60, 90 reduced the GR by 6.6 + 8.8%, 16.6 + 9.3 and 30.8 + 7.6
Brown et al. 2009	Randomized crossover	46M, obese/ Overweight, 40–65 y	Green Tea, purified extract, > 97% epi-gallocatechingallate	Lactose	8 wks	OGTT, AUC HOMO, fasting Glc/insulin	no change in insulin sensitivity/ secretion or Glc tolerance
Josic et al. 2010	Randomized crossover	14(7M/7F), healthy, 27 ± 3, BMI 22.3 ± 3.4	Green Tea, beverage + breakfast, flavan-3-ols	Water + breakfast	120 mins	OGTT	no Glc/insulin lowering, increased satiety
Bryans et al. 2007	Randomized crossover	16(4M/8F), healthy, 35.5 ± 1.5 y, BMI 23.8 ± 0.7	Black tea, beverage, flavan-3-ols, theaflavins	Water, caffeine, Glc	120 mins	OGTT	late phase plasma Glcresponse/ elevated insulin
Johnston et al. 2003	Randomized crossover	9, healthy, 26 ± 3.2 y, BMI < 25	Coffee, beverage (caffeinated/ decaffeinated chlorogenic acid caffeine	Water	3 h	OGTT	increased Glc/insulin; delayed GI glucose absorption
Nagao et al. 2009	Controlled DB	1) 23(15M/8F), T2DM (no ins.), 64.9 ± 1.6 y, BMI 25.6 ± 0.8 2) 20(10M/10F) 62.8 ± 2.2 y, BMI 24.0 ± 0.9	Green tea, (catechin rich) beverage, flavan-3-ols	Low-catechin beverage	12 wks	plasma glucose, insulin HbA1c	Increased insulin, waist circumference, & adiponectin

DB, double blind; SB, single blind; IDMM, insulin-dependent diabetes mellitus, NS, no significant effect; IR, insulin response; WB, white bread; T2DM, type 2 diabetes; Glc, glucose; HDL, high-density lipoprotein; PPG postprandial glycemia; IGT, impaired glucose tolerance; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified) iAUC, integrated area under the curve; AUC, area under the curve; CHO, carbohydrate; DF, dietary fiber; OGTT, oral glucose tolerance test; HOMA-IR, homeostasis model assessment for insulin resistance; CRP c-reactive protein.

Table 9 Effect of miscellaneous food sources (water and low-calorie sweeteners) on postprandial glycemia

Reference	Design	Subjects	Source	Daily intake	Duration	Outcome measures	Outcome
Torsdottir et al. 1989	Randomized crossover controlled	7, healthy, 23–31y, BMI: 21.0–29.4; 20, T2DM well controlled: 46–67 y, BMI 21.5–31.8, Poorly controlled 44–71 y, BMI19.2–27.6	Water, test meal: boiled potatoes, beef, fried in margarine (415 kcal, 55 EN% CHO, 2.8 fiber) with or without water	300 mL	180 min	iAUC	iAUC increase in Glc, 68% for healthy, 40% for well controlled DM2, NS for poorly controlled DM2, time to glucose peak: NS in HV, 58 (water) min vs. 69 in well controlled DM2, NS in poorly controlled DM2
Nehrling et al. 1985	Randomized placebo-controlled parallel DB	32 T1DB, 31 T2DB, mean 18–65 y	Aspartame, with meal	0.9 g × 3 for 18 wks		Fasting Glc/ insulin, PPG and HbA1c	NS for fasting Glc, 2h PPG or HbA1c
Okuno et al. 1986	Crossover	7, healthy, 46.7 y	Aspartame or Glc 100 g	Single dose 500 mg	180 min		Small, but significant decrease in Glc (mean in healthy 7 mg/dl, 14–28 mg in 3 subgroups of DM). NS for insulin or glucagon
Okuno et al. 1998	Not blinded, not randomized	9 T2DM (hospitalized), mean 57 y, mean duration of diabetes 5 y	Aspartame, in jelly cake given as dessert, No control Group	125 mg for 2 wks	180 min	OGTT	NS for OGGT after 2 weeks, total cholesterol, HDL or triglycerides
Grotz et al. 2003	Randomized double blind Placebo-controlled	128, T2DM	Sucralose	667 mg/d for 13 wks		Fasting Glc HbA1c serum C-peptide levels	NS fasting Glc, HbA1c or serum C-peptide levels
Mezitis et al. 1996	Double blind crossover	13, T1DM; 13, T2DM	Sucralose	Single dose 1000 mg		IAUC Serum C-peptide levels	NS for IAUC or serum C-peptide levels
Raben et al. 2011	Randomized placebo-controlled parallel	33, healthy, 20–50y; BMI 25–30, 12 sucrose group, 11 sweeteners group	Foods and drinks Containing Sucrose (∼2g/kg BW) or artificial sweeteners in the diet	10 weeks		Fasting Glc/ insulin, IAUC PPG and HbA1c	NS for fasting Glc, 2h PPG or HbA1c

DB, double blind; NS, no significant effect; T2DM, type 2 diabetes; T1DM, type 1 diabetes; Glc, glucose; HDL, high-density lipoprotein; PPG postprandial glycemia; BMI, body mass index (kg m⁻²; expressed as mean unless otherwise specified) iAUC, integrated area under the curve; OGTT, oral glucose tolerance test.

Figure 2 Overview of proposed mechanisms by which glucose and leucine stimulate insulin secretion. GK, glucokinase; PDC, pyruvate dehydrogenase complex; PC, pyruvate carboxylase; TCA, tricarboxylic acid; α-KG, α-ketoglutarate; AT, aminotransferase; BCKDH, branched-chain a-keto-acid dehydryogenase; GDH, glutamate dehydrogenase; KIC, a-ketoisocaproate. Adopted form van Loon et al; Current opinion in clinical nutrition and metabolic care, 2012, 15: 71–77.

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