BACKGROUND: The purpose of this prospective open-label trial was (1) to assess the influence of oral antidiabetic drugs (OAD) on the glycemic index (GI), glucose response curves (GRCs), daily mean plasma glucose (MPG) and (2) to compare the GI of foods in persons with OAD-treated type 2 diabetes mellitus (T2DM) with the respective GI in healthy persons (HP). METHODS: Tested foods containing 50 g of carbohydrates were eaten for breakfast and dinner after 10 and 4 h of fasting, respectively. Glycemic index, GRC, and MPG were obtained using the CGMS System Gold (CGMS). In T2DM patients [n = 16; age (mean +/- standard error) 56.0 +/- 2.25 years], foods were tested four times: tests 1, 2, and 3 were performed within one week in which placebo was introduced on day 2, and test 4 was carried out five weeks after reintroduction of OAD. Glycemic indexes, GRC, and MPG from tests 1, 2, 3, and 4 were compared. In a control group of 20 HP (age 24.4 +/- 0.71 years), the mean GIs were calculated as the mean from 20 subject-related GIs. RESULTS: In T2DM patients, subject-related assessment of GIs, GRC, and MPG distinguished persons with and without OAD effect. Nevertheless, the group-related GIs and the MPG on days 2, 8, and 39 showed no significant difference. There was no significant difference between the GIs in OAD-treated T2DM patients (test 4) versus HP (except in apple baby food). Glucose response curves were significantly larger in T2DM patients (test 4) versus HP. CONCLUSIONS: Determination of GRC and subject-related GI using the CGMS appears to be a potential means for the evaluation of efficacy of OAD treatment. Further studies are underway.

Department of Physiology Faculty of Medicine Palacky University Olomouc Czech Republic

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Otto H, Bleyer G, Pennartz M, Sabin G, Schauberger G, Spaethe R. Kohlenhydrataustausch nach biologischen Äquivalenten. [Exchange of Carbohydrates according to biological equivalents.] In: Spaethe R, editor. Diätetik bei Diabetes mellitus. [Diet in diabetes mellitus.] Bern: 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

Barclay AW, Petocz P, McMillan-Price J, Flood VM, Prvan T, Mitchell P, Brand-Miller JC. Glycemic index glycemic load, and chronic disease risk-a meta-analysis of observational studies. Am J Clin Nutr. 2008;87(3):627–637. PubMed

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

Hare-Bruun H, Nielsen BM, Grau K, Oxlund AL, Heitmann BL. Should glycemic index and glycemic load be considered in dietary recommendations? Nutr Rev. 2008;66(10):569–590. PubMed

Hermansen ML, Eriksen NM, Mortensen LS, Holm L, Hermansen K. Can the glycemic index (GI) be used as a tool in the prevention and management of type 2 diabetes? Rev Diabet Stud. 2006;3(2):61–71. PubMed PMC

Food and 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

Brand JC, Colagiuri S, Crossman S, Allen A, Roberts DC, Truswell AS. Low-glycemic index foods improve long-term glycemic control in NIDDM. Diabetes Care. 1991;14(2):95–101. PubMed

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(8):2261–2267. PubMed

Brand-Miller JC. Postprandial glycemia, glycemic index, and the prevention of type 2 diabetes. Am J Clin Nutr. 2004;80(2):243–244. PubMed

Burani J, Longo PJ. Low-glycemic index carbohydrates: an effective behavioral change for glycemic control and weight management in patients with type 1 and 2 diabetes. Diabetes Educ. 2006;32(1):78–88. PubMed

Heilbronn LK, Noakes M, Clifton PM. The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control. J Am Coll Nutr. 2002;21(2):120–127. PubMed

Järvi AE, Karlström BE, Granfeldt YE, Björck IE, Asp NG, Vessby BO. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low-glycemic index diet in type 2 diabetic patients. Diabetes Care. 1999;22(1):10–18. PubMed

Peterson K, Zapletalova J, 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

Langova K, Pribylova H, Kajabova M, Luza J. Assessment of haemoglobin A1c evolution using two statistical approaches (survival analysis and linear regression) in persons with diabetes mellitus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009;153(2):137–43. PubMed

Blevins TC. Professional continuous glucose monitoring in clinical practice 2010. J Diabetes Sci Technol. 2010;4(2):440–456. PubMed PMC

Mlĉák P, Fialová J, Trnková K, Chlup R. A continuous 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

Chlup R, Payne M, Zapletalova J, 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

Chlup R, Seckar P, Zapletalová J, Langová K, Kudlová P, Chlupová K, Bartek J, Jelenová D. Automated computation of glycemic index for foodstuffs using continuous glucose monitoring. J Diabetes Sci Technol. 2008;2(1):67–75. PubMed PMC

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

Riccardi G, Rivellese AA, Giacco R. Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008;87(1):269S–274S. PubMed

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(8):1866–1872. PubMed

Slama G, Elgrably F, Kabir M, Rizkalla SW. Role of low-glycemic-index foods in improving overall glycemic control in type 1 and type 2 diabetic patients and correcting excessive postprandial hyperglycemia. Horm Metab Res. 2006;38(7):465–458. PubMed

Wolever TM, Jenkins DJ, Josse RG, Wong GS, Lee R. The glycemic index: similarity of values derived in insulin-dependent and non-insulin-dependent diabetic patients. J Am Coll Nutr. 1987;6(4):295–305. PubMed

Ma Y, Olendzki BC, Merriam PA, Chiriboga DE, Culver AL, Li W, Hébert JR, Ockene IS, Griffith JA, Pagoto SL. A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes. Nutrition. 2008;24(1):45–56. PubMed PMC

Brouns F, Bjorck I, Frayn KN, Gibbs AL, Lang V, Slama G, Wolever TM. Glycaemic index methodology. Nutr Res Rev. 2005;18(1):145–171. PubMed

Wolever TM, Jenkins DJ, Jenkins AL, Josse RG. The glycemic index: methodology and clinical implications. Am J Clin Nutr. 1991;54(5):846–854. 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–257S. PubMed

Brand JC, Nicholson PL, Thorburn AW, Truswell AS. Food processing and the glycemic index. Am J Clin Nutr. 1985;42(6):1192–1196. PubMed

Wolever TM, Bolognesi C. Source and amount of carbohydrate affect postprandial glucose and insulin in normal subject. J Nutr. 1996;126(11):2798–2806. PubMed

Brand-Miller J, Wolever TM, Foster-Powell K, Colagiuri S. The new glucose revolution. Vol. 33. New York: Marlowe & Company; 2003. All about the glycemic index.

Chlup R, Jelenová D, Kudlová P, Chlupová K, Bartek J, Zapletalová J, Langová K, Chlupová L. Continuous glucose monitoring—a novel approach to the determination of the glycaemic index of foods (DEGIF1)—determination of the glycaemic index of foods by means of the CGMS. Exp Clin Endocrinol Diabetes. 2006;114(2):68–74. PubMed

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;87:638–644. PubMed

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

Gross TM, Mastrototaro J. Efficacy and reliability of the continuous glucose monitoring system. Diabetes Technol Ther. 2000;2(Suppl 1):19–26. PubMed

Klonoff DC. A review of continuous glucose monitoring technology. Diabetes Technol Ther. 2005;7(5):770–775. PubMed

Wallace A, Willis J, Monro J, Frampton C, Hederley D, Scott R. No difference between venous and capillary blood sampling and the Minimed continuous glucose monitoring system for determining the blood glucose response to food. Nutr Res. 2006;26(8):403–408.

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

Jadviscokova T, Fajkusova Z, Pallayova M, Luza J, Kuzmina G. Occurence of adverse events due to continuous glucose monitoring. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(2):263–266. PubMed

Brand Miller JC, Stockmann K, Atkinson F, Petocz P, Denyer G. Glycemicindex, 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;89:97–105. PubMed

Chlup R, Peterson K, Zapletalová J, Kudlová P, Seĉkar^ P. Extended Prandial Glycemic Profiles of Foods as Assessed Using Continuous Glucose Monitoring Enhance the Power of the 120-Minute Glycemic Index. J Diabetes Sci Technol. 2010;4(3):615–624. PubMed PMC

Davidson MB, Peters AL. An overview of metformin in the treatment of type 2 diabetes mellitus. Am J Med. 1997;102(1):99–110. PubMed

DeFronzo RA, Goodman AM, Multicenter Metformin Study Group Efficacy of metformin in patients with non-insulin-dependent diabetes mellitus. N Engl J Med. 1995;333:541–549. PubMed

Automated computation of glycemic index for foodstuffs using continuous glucose monitoring