RSS-Feed abonnieren
DOI: 10.1055/s-0029-1234107
© Georg Thieme Verlag KG Stuttgart · New York
Improved Metabolic Control After 12-Week Dietary Intervention with Low Glycaemic Isomalt in Patients with Type 2 Diabetes Mellitus
Publikationsverlauf
received 30.01.2009
accepted 13.07.2009
Publikationsdatum:
21. August 2009 (online)

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.
Key words
glycaemic index - glycaemic load - carbohydrate metabolism
References
- 1
Yach D, Stuckler D, Brownell KD.
Epidemiology and economic consequences of the global epidemics of obesity and diabetes.
Nat Med.
2006;
12
62-66
MissingFormLabel
- 2
Zimmet P, Alberti KG, Shaw J.
Global and societal implications of the diabetes epidemic.
Nature.
2001;
414
782-787
MissingFormLabel
- 3
Dickinson S, Brand-Miller J.
Glycemic index, postprandial glycemia and cardiovascular disease.
Curr Opin Lipidol.
2005;
16
69-75
MissingFormLabel
- 4
Ludwig DS, Eckel HE.
The glycemic index at 20 y.
Am J Clin Nutr.
2002;
76
S264-S265
MissingFormLabel
- 5
Livesey G, Buss D, Coussement P, Edwards DG, Howlett J, Jonas DA, Kleiner JE, Müller D, Sentko A.
Suitability of traditional energy values for novel foods and food ingredients.
Food Control.
2000;
11
249-289
MissingFormLabel
- 6
Gehring F, Karle EJ.
Sweetening agent, Palatinit under specific consideration as to microbiological and
caries-prophylactic aspects.
Z Ernährungswiss.
1981;
20
96-106
MissingFormLabel
- 7
Langkilde AM, Andersson H, Schweizer TF, Wursch P.
Digestion and absorption of sorbitol, maltitol and isomalt from small bowel.
A study in ileostomy subjects. Eur J Clin Nutr.
1994;
48
768-775
MissingFormLabel
- 8
Life Science Research Office
.
The Evaluation of the Energy of Certain Sugar Alcohols used as Food Ingredients . Bethesda, MD: Life Science Research Office, Federation of the American Society for Experimental Biology 1994MissingFormLabel - 9
Livesey G.
Health potential of polyols as sugar replacers, with emphasis on low glyceamic properties.
Nutr Res Rev.
2003;
16
163-289
MissingFormLabel
- 10 Bär A. Factorial calculation model fort he estimation of the physiological caloric value
of polyols. In: Hosoxa N, ed
Proceedings of the International Symposium on Caloric Evaluation of Carbohydrates . Tokyo: Research Foundation for Sugar Metabolism 1990: 209-257MissingFormLabel - 11
Atkinson FS, Foster-Powell K, Brand-Miller JC.
International tables of glycemic index and glycemic load values: 2008.
Diabetes Care.
2008;
31
2281-2283
MissingFormLabel
- 12
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC.
Homeostasis model assessment: insulin resistance and beta-cell function from fasting
plasma glucose and insulin concentrations in man.
Diabetologia.
1985;
28
412-419
MissingFormLabel
- 13
Gostner A, Schäffer V, Theis S, Menzel T, Lührs H, Melcher R, Schauber J, Kudlich T, Dusel G, Dorbath D, Kozianowski G, Scheppach W.
Effects of isomalt consumption on gastrointestinal and metabolic parameters in healthy
volunteers.
Br J Nutr.
2005;
94
575-581
MissingFormLabel
- 14
Brand-Miller J, Hayne S, Petocz P, Colagiuri S.
Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized
controlled trials.
Diabetes Care.
2003;
26
2261-2267
MissingFormLabel
- 15
Opperman AM, Venter CS, Oosthuizen W, Thompson RL, Vortser HH.
Meta-analysis of the health effects of using the glycemic index in meal-planning.
Br J Nutr.
2004;
92
367-381
MissingFormLabel
- 16
Livesey G, Taylor R, Hulshof T, Howlett J.
Glycemic response and health – a systematic review and meta-analysis: relations between
dietary glycemic properties and health outcomes.
Am J Clin Nutr.
2008;
87
((Suppl))
258S-268S
MissingFormLabel
- 17
Tushuizen ME, Diamant M, Heine RJ.
Postprandial dysmetabolism and cardiovascular disease in type 2 diabetes.
Postgrad Med J.
2005;
81
1-6
MissingFormLabel
- 18
Ginsberg HN, Illingworth DR.
Postprandial dyslipidemia: an atherogenic disorder common in patients with diabetes
mellitus.
Am J Cardiol.
2001;
88
9H-15H
MissingFormLabel
- 19
Gokulakrishnan K, Deepa R, Velmurugan K, Ravikumar R, Karkuzhali K, Mohan V.
Oxidised low-density lipoprotein and intimal medial thickness in subjects with glucose
intolerance: the Chennai Urban Rural Epidemiology Study-25.
Metabolism.
2007;
56
245-250
MissingFormLabel
- 20
Hawkins M, Tonelli J, Kishore P, Stein D, Ragucci E, Gitig A, Reddy K.
Contribution of elevated free fatty acid levels to the lack of glucose effectiveness
in type 2 diabetes.
Diabetes.
2003;
52
2748-2758
MissingFormLabel
- 21
Pilz S, Scharnagl H, Tiran B, Seelhorst U, Wellnitz B, Boehm BO, Schaefer JR, Marz W.
Free fatty acids are independently associated with all-cause and cardiovascular mortality
in subjects with coronary artery disease.
J Clin Endocrinol Metab.
2006;
91
2542-2547
MissingFormLabel
- 22
Rizkalla SW, Taghrid L, Laromiguiere M, Huet D, Boillot J, Rigoir A, Elgrably F, Slama G.
Improved plasma glucose control, whole-body glucose utilization, and lipid profile
on a low-glycemic index diet in type 2 diabetic men: a randomized controlled trial.
Diabetes Care.
2004;
27
1866-1872
MissingFormLabel
- 23
Ren S, Lee H, Hu L, Lu L, Shen GX.
Impact of diabetes-associated lipoproteins on generation of fibrinolytic regulators
from vascular endothelial cells.
J Clin Endocrinol Metab.
2002;
87
286-291
MissingFormLabel
- 24
Juhan-Vague I, Alessi MC.
PAI-1, obesity, insulin resistance and risk of cardiovascular events.
Thrombosis and haemostasis.
1997;
78
656-660
MissingFormLabel
- 25
Clausen P, Feldt-Rassmussen B, Jensen G, Jensen JS.
Endothelial haemostatic factors are associated with progression of urinary albumin
excretion in clinically healthy subjects: a 4-year prospective study.
Clin Sci.
1999;
97
37-43
MissingFormLabel
- 26
Hayden MR, Tyagi SC.
Uric acid: A new look at an old risk marker for cardiovascular disease, metabolic
syndrome, and type 2 diabetes mellitus: The urate redox shuttle.
Nutr Metab (Lond).
2004;
1
10
MissingFormLabel
- 27
Kadowaki T, Yamauchi T, Kubota N, Hara K, Ueki K, Tobe K.
Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic
syndrome.
J Clin Invest.
2006;
116
1784-1792
MissingFormLabel
- 28
Rothenbacher D, Brenner H, Marz W, Koenig W.
Adiponectin, risk of coronary heart disease and correlations with cardiovascular risk
markers.
Eur Heart J.
2005;
26
1640-1646
MissingFormLabel
- 29
Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE, Tataranni PA.
Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin
resistance and hyperinsulinemia.
J Clin Endocrinol Metab.
2001;
86
1930-1935
MissingFormLabel
- 30
Qi L, Meigs JB, Liu S, Manson JE, Mantzoros C, Hu FB.
Dietary fibers and glycemic load, obesity, and plasma adiponectin levels in women
with type 2 diabetes.
Diabetes Care.
2006;
29
1501-1505
MissingFormLabel
- 31
Anderlova K, Kremen J, Dolezalova R, Housova J, Haluzikova D, Kunesova M, Haluzik M.
The influence of very-low-calorie diet on serum leptin, soluble leptin receptor, adiponectin
and resistin levels in obsese women.
Physiol Res.
2006;
55
277-283
MissingFormLabel
- 32
Bouche C, Rizkalla SW, Luo J, Vidal H, Veronese A, Pacher N, Fouquet C, Lang V, Slama G.
Five-week, low-glycemic index diet decreases total fat mass and improves plasma lipid
profile in moderately overweight nondiabetic men.
Diabetes Care.
2002;
25
822-828
MissingFormLabel
- 33
McMillan-Price J, Petocz P, Atkinson F, O’Neill K, Samman S, Steinbeck K, Caterson I, Brand-Miller J.
Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk
reduction in overweight and obese young adults: a randomized controlled trial.
Arch Intern Med.
2006;
166
1466-1475
MissingFormLabel
- 34
Ebbeling CB, Leidig MM, Sinclair KB, Hangen JP, Ludwig DS.
A reduced-glycemic load diet in the treatment of adolescent obesity.
Arch Pediatr Adolesc Med.
2003;
157
773-779
MissingFormLabel
- 35
Williams KV, Kelley DE.
Metabolic consequences of weight loss on glucose metabolism and insulin action in
type 2 diabetes.
Diabetes Obes Metab.
2000;
2
121-129
MissingFormLabel
- 36
Wing RR, Koeske R, Epstein LH, Nowalk MP, Gooding W, Becker D.
Long-term effects of modest weight loss in type II diabetes patients.
Arch Intern Med.
1987;
147
749-753
MissingFormLabel
- 37
Watts NB, Spanheimer RG, DiGirolamo M, Gebhart SS, Musey VC, Siddig YK, Phillips LS.
Prediction of glucose response to weight loss in patients with non-insulin-dependent
diabetes mellitus.
Arch Intern Med.
1990;
150
803-806
MissingFormLabel
- 38
Blonk MC, Jacobs MA, Biesheuvel EH, Weeda-Mannak WL, Heine RJ.
Influences on weight loss in type 2 diabetic patients: little long-term benefit from
group behaviour therapy and exercise training.
Diabet Med.
1994;
11
449-457
MissingFormLabel
Correspondence
I. Holub
University of Würzburg
Department of Medicine II
Division of Gastroenterology
Grombühlstraße 12
Haus Auvera
97080 Würzburg
Germany
Telefon: + 49/931/201 458 87
Fax: + 49/931/201 458 29
eMail: holub_i@medizin.uni-wuerzburg.de