Efficacy of diet containing D-allulose in patients with type 2 diabetes

In a recent study published in nutrientsinvestigators evaluated the efficacy of a diabetic diet containing D-allulose in patients with type 2 diabetes (T2D).

Background

Diabetes is a widespread disease worldwide, most of which is type 2, characterized by insulin resistance and decreased insulin secretion. His basic T2D treatment includes dietary modification, regular physical activity, and medication. However, lifestyle is most important in reducing the burden of diabetes.

Excessive sugar intake increases the risk of obesity, cardiovascular disease and diabetes. Artificial sweeteners have been used as a safe sugar substitute among diabetics. However, there are concerns that artificial sweeteners may exacerbate glucose metabolism. D-allulose is his C-3 isomer of D-fructose, a rare sugar with proven anti-obesity and anti-diabetic properties.

About research

In the current prospective, randomized, single-blind, crossover controlled study, investigators investigated whether a diet containing D-allulose could improve glycemic control in T2D patients.

The study included 24 people admitted to Kagawa University Hospital from December 2019 to August 2022. Blood glucose levels were measured using a continuous blood glucose monitoring system (isCGM) with intermittent scanning. Only willing hospitalized T2D patients aged 20-80 years with glycated hemoglobin (HbA1c) levels ≥6.50% were included.

Participants were divided into two groups, A and B. Individuals in Group A were fed a diabetic diet three times a day for two days. After a rest period of at least 1.0 days, participants were fed a diabetic diet containing D-allulose three times daily for two days. Diet was reversed among group B individuals. Total daily energy intake was determined according to the Japan Diabetes Society Diabetes Care Guidelines 2019.

C-peptide immunoreactivity (CPR) and insulin immunoreactivity (IRI) were measured. The primary endpoint was peak postprandial blood glucose (PPG) levels following a standardized diabetic diet and a meal containing 8.50 g D-allulose.

Secondary endpoints of the study included PPG trend assessed using the isCGM system, duration of blood glucose in the target range of 70.0 to 180.0 mg/dL. [percent time in range (TIR)]duration of hypoglycemic episodes (<70.0 mg/dL) less than TIR [percent time below range (TBR)]and episodes of hyperglycemic episodes (>180.0 mg/dL) > TIR [percent time above range (TAR)].

Safety endpoints included change in the number of diarrhea episodes. In addition, participants completed questionnaires about satisfaction, smell, taste and color. The research team investigated subjects taking alpha-glucosidase inhibitors, those with a positive history of serious adverse events after taking D-allulose, and those with serological creatinine ≥1.50 mg/dL (severe renal impairment). shown) were excluded.

In addition, pregnant and lactating women, those taking part in other trials, and those deemed unfit for the trial by a physician were excluded. Linear mixed-effects modeling was used for the analysis.

result

Initially, 45 were screened for eligibility, 21 who did not meet inclusion criteria were excluded, and 24 were enrolled in the study. However, four people dropped out of the study, reducing the final sample size to her 20. Mean peak PPG values ​​for the D-allulose-containing diet and the standard diabetic diet were 173.0 mg/dL and 191.0 mg/dL, respectively.

The results of this study showed that a diabetic diet containing D-allulose significantly reduced PPG levels in T2D patients compared to a strictly energy-controlled diabetic diet. Furthermore, a protective effect on the endogenous insulin secretory capacity of the pancreas was observed due to the reduced insulin requirement. Carryover effects were negligible and there were no washout issues.

The D-allulose diet decreased the area under the curve (AUC) from 0.0 to 180.0 min PPG levels (25,408 vs 27,550 mg-min/dL) and %TAR values ​​(30% vs 21%). However, no statistically significant changes were observed in the TIR ratio (68% vs. 74%) and TBR values, nor was there an increase in the frequency of hypoglycemic episodes (2.10% vs. 5.0%).

CPR levels decreased significantly as blood glucose readings decreased. No significant differences were observed in satiety, smell, taste, or color. There were no significant changes in diarrhea frequency and no safety concerns. None of the participants complained of smells or tastes, and none could distinguish between the two meals.

Mechanisms underlying the hypoglycemic effect of D-allulose include inhibition of monosaccharide absorption by intestinal cells, promotion of glycogen synthesis by activation of glucokinase in the liver, protection of the pancreas, and improvement of the ability of the pancreas to secrete insulin. reported. D-allulose improves glucose tolerance and reduces appetite by increasing the secretion of glucagon-like peptide-1 (GLP-1) and altering central nervous system (CNS) activity via the vagus nerve. There is a possibility.

Based on the study results, a diabetic diet containing 8.50 g of D-allulose can effectively improve postprandial blood glucose levels, and D-allulose may improve glucose tolerance and protect pancreatic β-cells in T2D patients. indicates that However, further studies, including larger sample sizes and longer follow-up, are needed to increase the validity of the study results.