PracticeUpdate: Endocrinology

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Awhey/guar “preload” improves postprandial glycaemia and HbA in type 2 diabetes In well controlled patients with type 2 diabetes, 12 weeks’ treatment with a low dose whey/guar preload taken twice daily before meals has been shown to reduce postprandial blood glucose. T his outcome of a 12-week, single-blind, randomised, placebo-controlled trial was

EDITORIAL Managing Editor Anne Neilson anne.neilson@elsevier.com Editor Carolyn Ng carolyn.ng@elsevier.com Designer Jana Sokolovskaja j.sokolovskaja@elsevier.com

of age; body mass index 29.5 ± 5.1 kg/m 2 ; haemoglobin A1c 6.5 ± 0.5%; 24 managed by diet alone and 23 by metformin) received 150 mL flavoured shakes contain- ing either 20 g whey protein and 5 g guar (90 kcal), or flavoured placebo (0 kcal), 15 minutes before two meals each day, for 12 weeks. No other specific dietary advice was given. During the first day (week 1) and last day (week 12) of treatment, pa- tients attended the laboratory after an overnight fast and consumed the whey/guar or placebo preload shake 15 minutes before a mashed potato meal (368.5kcal: 61.4 g carbohy- drate, 7.4 g protein, and 8.9 g fat) labelled with 13C-octanoic acid. Venous blood was sampled

frequently for measurement of glu- cose, and gastric 50% emptying time was calculated by quantifying breath 13C over 240 minutes. Haemoglo- bin A1c was measured on the first and last day of treatment. Gastric emptying was slower after the whey/guar preload than after pla- cebo at the beginning of treatment (gastric 50% emptying time: whey/ guar 192.4 ± 9.2 minutes, placebo 167.2 ± 7.2 minutes, P < 0.05), though this effect was attenuated after 12 weeks (gastric 50% emp- tying time: whey/guar 177.2 ± 8.6 minutes, placebo 163.7 ± 7.5 min- utes, difference not significant). Postprandial blood glucose concen- trations were lower after the whey/ guar preload than after placebo at both the beginning (P <  0.0001) and end (P< 0.0001) of treatment, without any attenuation of this effect at 12 weeks. During both week 1 (r = –0.58, P = 0.0001) and week 12 (r = –0.57, P = 0.0001) an inverse relationship was observed between blood glucose at 60 minutes and gastric 50% emptying, so that when gastric emptying was more relatively rapid, the glycaemic response was greater. Haemoglobin A1c decreased by 0.1 ± 0.1% (1.0 ± 0.6 mmol/ mol) with the whey/guar preload and increased by 0.2 ± 0.1% (2.0 ± 0.8 mmol/mol) with placebo (P = 0.005). No meaningful changes in body weight were observed in ei- ther group (placebo –0.4 ± 0.3 kg, whey/guar –0.4 ± 0.3 kg). Dr Rayner concluded that in well controlled patients with type 2 diabetes, 12 weeks’ treatment with a low-dose whey/guar preload taken twice daily before meals was shown to reduce postprandial blood glucose, was associated with a slow- ing of gastric emptying, and led to a modest improvement in haemoglo- bin A1c.

reported at the EASD 2016 meeting. Chris K. Rayner, PhD, of the University of Adelaide, Australia, explained that his team has shown that whey “preloads,” taken before meals for up to 4 weeks, slow gastric emptying and reduce postprandial glycaemia in type 2 diabetes. Guar also slows carbohydrate absorp- tion. Dr  Rayner and colleagues evaluated the effects of 12 weeks’ treatment with a whey/guar preload on gastric emptying, postprandial blood glucose, and overall glycaemic control (haemoglobinA1c), in type 2 diabetes. Forty-seven patients with type 2 diabetes (26 males; age 64 ± 7 years

SALES Commercial Manager Fleur Gill fleur.gill@elsevier.com

Whey “preloads,” taken before meals for up to 4 weeks, slow gastric emptying and reduce postprandial glycaemia in type 2 diabetes. Guar also slows carbohydrate absorption.

Account Manager Linnea Mitchell-Taverner l.mitchell-taverner@elsevier.com

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VOL. 1 • No. 3 • 2016