BACKGROUND: The glycemic index (GI) is routinely measured 120 minutes after food intake (GI120). The purpose of this prospective open label study was to assess (1) the dynamics of glycemia over the 210 minutes following food consumption and (2) the evolution of GIs based on 120-, 150-, 180-, and 210-minute glycemic profiles. METHOD: Twenty healthy subjects (mean +/- SE; 21.9 +/- 1.39 years of age; body mass index 23.6 +/- 0.63 kg/m(2); 7 men and 13 women) completed the study. Each subject consumed 10 different foods with known GI120 on three separate occasions at four different times of day according to a defined meal plan over a 9-day period; 32 meals were evaluated. The GIs for intervals of 120, 150, 180 and 210 minutes after food consumption were determined using a continuous glucose monitoring system (CGMS) to measure glycemia. The Wilcoxon signed-rank test was applied to compare the GIs. RESULTS: Glycemia returned to baseline within 120 minutes for honey and tomato soup; within 210 minutes for white bread, choco-rice cookies, fish and potatoes, wafers, and meat ravioli with cheese; and later for dark chocolate, apricot dumplings, and choco-wheat cookies. The extended GIs were higher than the respective GI120s in eight of the foods. CONCLUSIONS: The 120-minute glycemic index fails to fully account for changes in glycemia after ingestion of a mixed meal because glycemia remains above baseline for a longer period. The CGMS is a convenient method to determine the glucose response/GIs over intervals extended up to 210 minutes, which is adequate time for the absorption of most foods.

Department of Physiology Faculty of Medicine Palacký University Olomouc Olomouc Czech Republic

See more in PubMed

Food Agriculture Organization/World Health Organization. Carbohydrates in human nutrition. Report of a Joint FAO/WHO Expert Consultation. FAO Food Nutr Pap. 1998;66:1–140. PubMed

Otto H, Bleyer G, Pennartz M, Sabin G, Schauberger G, Spaethe R. Exchange of carbohydrates according to biological equivalents. In: Otto H, Spaethe R, editors. Diet in diabetes mellitus. Bern Stuttgart Wien: Verlag Hans Huber; 1973. pp. 41–50.

Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins AL, Goff DV. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr. 1981;34(3):362–366. PubMed

Ionescu-Tîrgovişte C, Popa E, Sîntu E, Mihalache N, Cheţa D, Mincu I. Blood glucose and plasma insulin responses to various carbohydrates in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1983;24(2):80–84. PubMed

Wolever TM, Nuttall FQ, Lee R, Wong GS, Josse RG, Csima A, Jenkins DJ. Prediction of the relative blood glucose response of mixed meals using the white bread glycemic index. Diabetes Care. 1985;8(5):418–428. PubMed

Chantelau E, Spraul M, Kunze K, Sonnenberg GE, Berger M. Effects of the glycaemic index of dietary carbohydrates on prandial glycaemia and insulin therapy in type I diabetes mellitus. Diabetes Res Clin Pract. 1986;2(1):35–41. PubMed

Bruns W. Diet treatment. In: Bibergeil H, editor. Diabetes mellitus. Guidelines for the diabetes practice. Jena: VEB Gustav Fischer Verlag; 1989. pp. 254–316.

Brand-Miller J, Wolever TMS, Colagiuri S, Foster-Powell K. The new glucose revolution. Marlowe and Company; 2002.

Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values. Am J Clin Nutr. 2002;76(1):5–56. PubMed

American Diabetes Association. Executive summary: standards of medical care in diabetes–2010. Clinical practice recommendations. Diabetes Care. 2010;33(Suppl 1):S4–S61. PubMed PMC

Bode BW. Clinical utility of the continuous glucose monitoring system. Diabetes Technol Ther. 2000;2(Suppl 1):S35–S41. PubMed

Chlup R, Seckar P, et al. Langova K, Kudlova P, Chlupova K, Bartek J, Jelenova D. Automated computation of glycemic index for foodstuffs using continuous glucose monitoring. J Diabetes Sci Technol. 2008;2(1):67–75. PubMed PMC

Kohnert KD, Augstein P, Zander E, Heinke P, Peterson K, Freyse EJ, Hovorka R, Salzsieder E. Glycemic variability correlates strongly with postprandial β-cell dysfunction in a segment of type 2 diabetic patients using oral hypoglycemic agents. Diabetes Care. 2009;32(6):1058–1062. PubMed PMC

Pearce KL, Noakes M, Keogh J, Clifton PM. Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes. Am J Clin Nutr. 2008;87(3):638–644. PubMed

Zavalkoff S, Polychronakos S. Evaluation of conventional blood glucose monitoring as an indicator of integrated values using a subcutaneous sensor. Diabetes Care. 2002;25(9):1603–1606. PubMed

Peterson K, et al. Kudlova P, Matuskova V, Bartek J, Novotny D, Chlup R. Benefits of three-month continuous glucose monitoring for persons with diabetes using insulin pumps and sensors. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009;153(1):47–51. PubMed

Pribylova H, Pallayova M, Hucikova J, Luza J. Evaluation of the new software program DegifXL4 in the determination of the glycaemic indices of foodstuffs. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008;152(1):65–71. PubMed

Chlup R, Jelenova D, Kudlova P, Chlupova K, Bartek J, et al. Langova K, Chlupova L. Continuous glucose monitoring–a novel approach to the determination of the glycaemic index of foods (DEGIF 1)–determination of the glycaemic index of foods by means of the CGMS. Exp Clin Endocrinol Diabetes. 2006;114(2):68–74. PubMed

Sparks MJ, Selig SS, Febbraio MA. Pre-exercise carbohydrate ingestion: effect of the glycemic index on endurance exercise performance. Med Sci Sports Exerc. 1998;30(6):844–849. PubMed

Stevenson E, Williams C, McComb G, Oram C. Improved recovery from prolonged exercise following the consumption of low glycemic index carbohydrate meals. Int J Sport Nutr Exerc Metab. 2005;15(4):333–349. PubMed

Wee SL, Williams C, Tsintzas K, Boobis L. Ingestion of a high-glycemic index meal increases muscle glycogen storage at rest but augments its utilization during subsequent exercise. J Appl Physiol. 2005;99(2):707–714. PubMed

Visek J, Zourek M, Lacigova S, Rusavy Z. Influence of fiber on glycemic index of enteral nutrition. J Parenter Enteral Nutr. 2007;31(6):491–495. PubMed

Vega-López S, Ausman LM, Griffith JL, Lichtenstein AH. Inter-individual variability and intra-individual reproducibility of glycemic index values for commercial white bread. Diabetes Care. 2007;30(6):1412–1417. PubMed

Nell T, Venter Ch, Vorster H, Botes I, Steyn F. Intra- and inter-individual variation in glucose response to white bread and oral glucose in healthy women. South African J Clin Nutr. 2003;16:58–64.

Aston LM, Jackson D, Monshelmer S, Whybrow S, Handjieva-Darlenska T, Kreutzer M, Kohl A, Papadaki A, Martinez JA, Kunova V, Van Baak MA, Astrup A, Saris WH, Jebb SA, Lindroos AK. Developing a methodology for assigning glycaemic index values to foods consumed across Europe. Obesity Rev. 2009;11(1):92–100. PubMed

Fajkusova Z, Jadviscokova T, Pallayova M, Matuskova V, Luza J, Kuzmina G. Glycaemic index of selected foodstuffs in healthy persons. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(2):257–261. PubMed

Kudlová P, Stanislavová A. Education of healthy volunteers for the determination of glycemic index of foods. In: čáp J, Žiaková K, Nemčeková M, Holmanová E, editors. Theory, research and education in nursing. Univerzita Komenského Bratislava, Jeseniova Lekárska Fakulta Martin, Lékařská fakulta Univerzity Palackého Olomouc, čR; 2005. pp. 363–372.

Sydney University Glycemic Index Survey. Glycemic index; 2004. Available from: http://www.gisymbol.com.au/pages/index.asp.

Ganon MC, Nuttall FQ. Factors affecting interpretation of post-prandial glucose and insulin areas. Diabetes Care. 1987;10(6):759–763. PubMed

Nuttall FQ, Ganon MC. Plasma glucose and insulin response to macronutrients in nondiabetic and NIDDM subjects. Diabetes Care. 1991;14(9):824–838. PubMed

Wolever TM, Brand-Miller JC, Abernethy J, Astrup A, Atkinson F, Axelsen M, Björck I, Brighenti F, Brown R, Brynes A, Casiraghi MC, Cazaubiel M, Dahlqvist L, Delport E, Denyer GS, Erba D, Frost G, Granfeldt Y, Hampton S, Hart VA, Hätönen KA, Henry CJ, Hertzler S, Hull S, Jerling J, Johnston KL, Lightowler H, Mann N, Morgan L, Panlasigui LN, Pelkman C, Perry T, Pfeiffer AF, Pieters M, Ramdath DD, Ramsingh RT, Robert SD, Robinson C, Sarkkinen E, Scazzina F, Sison DC, Sloth B, Staniforth J, Tapola N, Valsta LM, Verkooijen I, Weickert MO, Weseler AR, Wilkie P, Zhang J. Measuring the glycemic index of foods: interlaboratory study. Am J Clin Nutr. 2008;87(1):247S–2457S. PubMed

Chlup R, Jelenova D, Chlupova K, et al. Chlupova L, Bartek J. Function and accuracy of glucose sensors beyond their stated expiry date. Diabetes Technol Ther. 2006;8(4):495–504. PubMed

Jadviscokova T, Fajkusova Z, Pallayova M, Luza J, Kuzmina G. Occurence of adverse events due to continous glucose monitoring. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(2):263–267. PubMed

Mlcak P, Fialova J, Trnkova K, Chlup R. A continous glucose monitoring system (CGMS)–a promising approach for improving metabolic control in persons with type 1 diabetes mellitus treated by insulin pumps. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004;148(1):33–38. PubMed

Mastrototaro J, Shin J, Marcus A, Sulur G. The accuracy and efficacy of real-time continuous glucose monitoring sensor in patients with type 1 diabetes. Diabetes Technol Ther. 2008;10(5):385–390. PubMed

Hirsch IB, Armstrong D, Bergenstal R, Buckingham B, Childs BP, Clarke WL, Peters A, Wolpert H. Clinical application of emerging sensor technologies in diabetes management: consensus guidelines for continuous glucose monitoring (CGM) Diabetes Technol Ther. 2008;10(4):232–245. PubMed

Maaze RS, Strock E, Borgman S, Wesley D, Stout P, Racchini P. Evaluating the accuracy, reliability and clinical applicability of continuous glucose monitoring (CGM): is CGM ready for real time? Diabetes Technol Ther. 2009;11(1):11–18. PubMed

Chlup R, Payne M, et al. Komenda S, Doubravova B, Reznickova M, Chlupova L, Seckar P. Results of selfmonitoring on glucometer systems Advance and Optium in daily routine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2005;149(1):127–139. PubMed

Liljeberg HG, Akerberg AK, Björck IM. Effect of the glycemic index and content of indigestible carbohydrates of cereal-based breakfast meals on glucose tolerance at lunch in healthy subjects. Am J Clin Nutr. 1999;69(4):647–655. PubMed

Nilsson AC, Ostman EM, Granfeldt Y, Björck IM. Effect of cereal test breakfasts differing in glycemic index and content of indigestible carbohydrates on daylong glucose tolerance in healthy subjects. Am J Clin Nutr. 2008;87(3):645–654. PubMed

Brand-Miller JC, Stockmann K, Atkinson F, Petocz P, Denyer G. Glycemic index, postprandial glycemia, and the shape of the curve in healthy subjects: analysis of a diabase of more than 1000 foods. Am J Clin Nutr. 2009;89(1):97–105. PubMed

Brynes AE, Adamson J, Dornhorst A, Frost GS. The beneficial effect of a diet with low glycaemic index on 24 h glucose profiles in healthy young people as assessed by continuous glucose monitoring. Br J Nutr. 2005;93(2):179–182. PubMed

Nakládalová M, Kapoun S. Occupational ability in persons with diabetes. Pracovní Lék. 2004;56:13–16.

Wu CL, Williams C. A low glycemic index meal before exercise improves endurance running capacity in men. Int J Sport Nutr Exerc Metab. 2006;16(5):510–527. PubMed

Lippaiova N, Pallayova M, Kuzmina G, Peterson K, Fajkosova L, Luza J. Safety of new algorithms for premeal insulin boluses in high glycaemic index meals in persons with type 1 diabetes mellitus using insulin pumps. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2008;152(1):73–77. PubMed

Brand-Miller JC, Wolever TM. The use of glycaemic index tables to predict glycaemic index of breakfast meals. Br J Nutr. 2005;94(1):133–134. PubMed

Monro JA, Shaw M. Glycemic impact, glycemic glucose equivalents, glycemic index, and glycemic load: definitions, distinctions, and implications. Am J Clin Nutr. 2008;87(1):237S–2343S. PubMed

Wolever TM, Yang M, Zeng XY, Atkinson F, Brand-Miller JC. Food glycemic index, as given in glycemic index tables, is a significant determinant of glycemic responses elicited by composite breakfast meals. Am J Clin Nutr. 2006;83(6):1306–1312. PubMed

Jenkins DJ, Kendall CW, Augustin LS, Franceschi S, Hamidi M, Marchie A, Jenkins AL, Axelsen M. Glycemic index: overview of implications in health and disease. Am J Clin Nutr. 2002;76(1):266–273. PubMed

Pawlak DB, Ebbeling CB, Ludwig DS. Should obese patients be counselled to follow a low-glycaemic index diet? Yes. Obes Rev. 2002;3(4):235–243. PubMed

Raben A. Should obese patients be counselled to follow a low-glycaemic index diet? Obes Rev. 2002;3(4):245–256. PubMed

Hollenbeck CB, Coulston AM. The clinical utility of the glycemic index and its application to mixed meals. Can J Physiol Pharmacol. 1991;69(1):100–107. PubMed

Williams SM, Venn BJ, Perry T, Brown R, Wallace A, Mann JI, Green TJ. Another approach to estimating the reliability of glycaemic index. Br J Nutr. 2008;100(2):364–372. PubMed

Influence of oral antidiabetic drugs on hyperglycemic response to foods in persons with type 2 diabetes mellitus as assessed by continuous glucose monitoring system: a pilot study