Hostname: page-component-7dc689bd49-g7gpc Total loading time: 0 Render date: 2023-03-21T02:03:27.040Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

High-carbohydrate–low-glycaemic index dietary advice improves glucose disposition index in subjects with impaired glucose tolerance

Published online by Cambridge University Press:  09 March 2007

Thomas M. S. Wolever*
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada M5S 3E2 and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
Christine Mehling
Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada M5S 3E2 and Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
*Corresponding author: Dr Thomas M. S. Wolever, fax +1 416 978 5882, email
Rights & Permissions[Opens in a new window]


HTML view is not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Controversy exists about the optimal amount and source of dietary carbohydrate for managing insulin resistance. Therefore, we compared the effects on insulin sensitivity (SI), pancreatic responsivity (AIRglu) and glucose disposition index (DI=SI×AIRglu) of dietary advice aimed at reducing the amount or altering the source of dietary carbohydrate in subjects with impaired glucose tolerance (IGT). Subjects were randomized to high-carbohydrate–high-glycaemic index (GI) (high-GI, n 11), high-carbohydrate–low-GI (low-GI, n 13), or low-carbohydrate–high-monounsaturated fat (MUFA, n 11) dietary advice, with SI, AIRglu and DI measured using a frequently sampled, intravenous glucose tolerance test before and after 4 months treatment. Carbohydrate and fat intakes and diet GI, respectively, were: high-GI, 53 %, 28 %, 83; low-GI, 55 %, 25 %, 76; MUFA, 47 %, 35 %, 82. Weight changes on each diet differed significantly from each other: high-GI, -0·49 (SEM 0·29) KG; LOW-GI, -0·19 (sem 0·40) kg; MUFA +0·27 (sem 0·45) kg. Blood lipids did not change, but glycated haemoglobin increased significantly on MUFA, 0·02 (sem 0·11) %, relative to low-GI, -0·19 (sem 0·08) %, and high-GI, -0·13 (sem 0·14) %. Diastolic blood pressure fell by 8 mmHg on low-GI relative to MUFA (P=0·038). Although SI and AIRglu did not change significantly, DI, a measure of the ability of β-cells to overcome insulin resistance by increasing insulin secretion, increased on low-GI by >50 % (P=0·02). After adjusting for baseline values, the increase in DI on low-GI, 0·17 (sem 0·07), was significantly greater than those on MUFA, -0·09 (sem 0·08) and high-GI, -0·03 (sem 0·02) (P=0·019). Thus, the long-term effects of altering the source of dietary carbohydrate differ from those of altering the amount. High-carbohydrate–low-GI dietary advice improved β-cell function in subjects with IGT, and may, therefore, be useful in the management of IGT.

Research Article
Copyright © The Nutrition Society 2002


American Diabetes Association (1997) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 20, 11831197.CrossRefGoogle Scholar
Balkau, B, Shipley, M, Jarrett, RJ, Pyörälä, L, Pyörälä, M, Forhan, A & Eschwège, E (1998) High blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men: 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helskinki Policemen Study. Diabetes Care 21, 360367.CrossRefGoogle Scholar
Boden, G, Chen, X, Ruiz, J, White, JV & Rossetti, L (1994) Mechanisms of fatty acid-induced inhibition of glucose uptake. Journal of Clinical Investigation 93, 24382446.CrossRefGoogle ScholarPubMed
Borkman, M, Campbell, LV, Chisholm, DJ & Storlien, LH (1991) Comparison of the effects on insulin sensitivity of high carbohydrate and high fat diets in normal subjects. Journal of Clinical Endocrinology and Metabolism 72, 432437.CrossRefGoogle ScholarPubMed
Carpentier, A, Mittelman, SD, Lamarche, B, Bergman, RN, Giacca, A & Lewis, GF (1999) Acute enhancement of insulin secretion by FFA in humans is lost with prolonged FFA elevation. American Journal of Physiology 276, E1055E1066.Google ScholarPubMed
Chen, M, Bergman, RN & Porte, D Jr (1988) Insulin resistance and β-cell dysfunction in aging: the importance of dietary carbohydrate. Journal of Clinical Endocrinology and Metabolism 67, 951957.CrossRefGoogle ScholarPubMed
Chew, I, Brand, JC, Thorburn, AW & Truswell, AS (1988) Application of the glycemic index to mixed meals. American Journal of Clinical Nutrition 47, 5356.CrossRefGoogle ScholarPubMed
Chiasson, JL, Josse, RG, Leiter, LA, Mihic, M, Nathan, DM, Palmason, C, Cohen, RM & Wolever, TMS (1996) The effect of acarbose on insulin sensitivity in subjects with impaired glucose tolerance. Diabetes Care 19, 11901193.CrossRefGoogle ScholarPubMed
Clausen, JO, Borch-Johnsen, K, Ibsen, H, Bergman, RN, Hougaard, P, Winther, K & Pedersen, O (1996) Insulin sensitivity index, acute insulin response, and glucose effectiveness in a population-based sample of 380 young healthy caucasians: analysis of the impact of gender, body fat, physical fitness and life-style factors. Journal of Clinical Investigation 98, 11951209.CrossRefGoogle Scholar
Del Prato, S, Leonetti, F, Simonson, DC, Sheehan, P, Matsuda, M & DeFronzo, RA (1994) Effect of sustained physiologic hyperinsulinaemia and hyperglycaemia on insulin secretion and insulin sensitivity in man. Diabetologia 37, 10251035.CrossRefGoogle ScholarPubMed
Despres, JP & Lamarche, B (1994) Low-intensity endurance exercise training, plasma lipoproteins and the risk of coronary heart disease. Journal of Internal Medicine 236, 722.CrossRefGoogle ScholarPubMed
Ferrannini, E (1998) Insulin resistance versus insulin deficiency in non-insulin-dependent diabetes mellitus: problems and prospects. Endocrine Reviews 19, 477490.CrossRefGoogle ScholarPubMed
Ferrari, P, Alleman, Y, Shaw, S, Riesen, W & Weidmann, P (1991) Reproducibility of insulin sensitivity measured by the minimal model method. Diabetologia 34, 527530.CrossRefGoogle ScholarPubMed
Finegood, DT, Hramiak, IM & Duprè, J (1990) A modified protocol for estimation of insulin sensitivity with the minimal model of glucose kinetics in patients with insulin-dependent diabetes. Journal of Clinical Endocrinology and Metabolism 70, 15381549.CrossRefGoogle ScholarPubMed
Food and Agricultural Organization of the United Nations (1998) Report of a Joint FAO/WHO Expert Consultation: Carbohydrates in Human Nutrition. FAO Food and Nutrition Paper no. 66. Rome: FAO.Google Scholar
Frost, G, Leeds, A, Trew, G, Margara, R & Dornhorst, A (1998) Insulin sensitivity in women at risk of coronary heart disease and the effect of a low glycemic index diet. Metabolism 47, 12451251.CrossRefGoogle Scholar
Garg, A, Bantle, JP, Henry, RR, Coulston, AM, Griver, KA, Raatz, SK, Brinkley, L, Chen, YDI, Grundy, SM, Huet, BA & Reaven, GM (1994) Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. Journal of the American Medical Association 271, 14211428.CrossRefGoogle ScholarPubMed
Garg, A, Grundy, SM & Unger, RH (1992) Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes 41, 12781285.CrossRefGoogle ScholarPubMed
Gerich, JE (1998) The genetic basis of type 2 diabetes mellitus: impaired insulin secretion versus impaired insulin sensitivity. Endocrine Reviews 19, 491503.CrossRefGoogle ScholarPubMed
Gordon, DJ & Rifkind, BM (1989) High-density lipoprotein – the clinical implications of recent studies. New England Journal of Medicine 321, 13111316.Google ScholarPubMed
Heymsfield, SB, Darby, PC, Muhlheim, LS, Gallagher, D, Wolper, C & Allison, DB (1995) The calorie: myth, measurement. and reality. American Journal of Clinical Nutrition 62, Suppl., 1034S1041S.CrossRefGoogle Scholar
Hokanson, JE & Austin, MA (1996) Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. Journal of Cardiovascular Risk 3, 213219.CrossRefGoogle ScholarPubMed
Hughs, VA, Fiatarone, MA, Fielding, RA, Ferrara, CM, Elahi, D & Evans, WJ (1995) Long-term effects of a high carbohydrate diet and exercise on insulin action in older subjects with impaired glucose tolerance. American Journal of Clinical Nutrition 62, 426433.CrossRefGoogle Scholar
Indar-Brown, K, Norenberg, C & Madar, Z (1992) Glycemic and insulinemic responses after ingestion of ethnic foods by NIDDM and healthy subjects. American Journal of Clinical Nutrition 55, 8995.CrossRefGoogle ScholarPubMed
Jenkins, DJA, Ghafari, H, Wolever, TMS, Taylor, RH, Barker, HM, Fielden, H, Jenkins, AL & Bowling, AC (1982) Relationship between the rate of digestion of foods and postprandial glycaemia. Diabetologia 22, 450455.CrossRefGoogle Scholar
Jeppesen, J, Schaaf, P, Jones, C, Zhou, M-Y, Chen, Y-DI & Reaven, GM (1997) Effects of low-fat, high-carbohydrate diets on risk factors for ischemic heart disease in postmenopausal women. American Journal of Clinical Nutrition 65, 10271033.CrossRefGoogle ScholarPubMed
Kahn, SE, Prigeon, RL, McCulloch, DK, Boyko, EJ, Bergman, RN, Schwartz, MW, Neifing, JL, Ward, WK, Beard, JC, Palmer, JP & Porte, D Jr (1993) Quantification of the relationship between insulin sensitivity and β-cell function in human subjects: evidence for a hyperbolic function. Diabetes 42, 16631672.CrossRefGoogle ScholarPubMed
Lissner, L & Lindroos, A-K (1994) Is dietary underreporting macronutrient-specific? European Journal of Clinical Nutrition 48, 453454.Google ScholarPubMed
Luscombe, ND, Noakes, M & Clifton, PM (1999) Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM. European Journal of Clinical Nutrition 53, 473478.CrossRefGoogle ScholarPubMed
Pacini, G & Bergman, RN (1986) MINMOD:.A computer program to calculate insulin sensitivity and pancreatic responsivity from the frequently sampled intravenous glucose tolerance test. Computer Methods and Programs in Biomedicine 23, 113122.CrossRefGoogle ScholarPubMed
Parks, EJ & Hellerstein, MK (2000) Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms. American Journal of Clinical Nutrition 71, 412433.CrossRefGoogle ScholarPubMed
Reaven, GM (1995) Pathophysiology of insulin resistance in human disease. Physiological Reviews 75, 473486.CrossRefGoogle ScholarPubMed
Reaven, GM (1997) Do high carbohydrate diets prevent the development or attenuate the manifestations (or both) of syndrome X? A viewpoint strongly against. Current Opinion in Lipidology 8, 2327.CrossRefGoogle Scholar
Salmerón, J, Ascherio, A, Rimm, EB, Colditz, GA, Spiegelman, D, Jenkins, DJ, Stampfer, MJ, Wing, AL & Willett, WC (1997 a) Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 20, 545550.CrossRefGoogle ScholarPubMed
Salmerón, J, Manson, JE, Stampfer, MJ, Colditz, GA, Wing, AL & Willett, WC (1997 b) Dietary fiber, glycemic load and risk of non-insulin-dependent diabetes mellitus in women. Journal of the American Medical Association 277, 472477.CrossRefGoogle ScholarPubMed
Schaefer, EJ, Lichtenstein, AH, Lamon-Fava, S, McNamara, JR, Schaefer, MM, Rasmussen, H & Ordovas, JM (1995) Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet. Journal of the American Medical Association 274, 14501455.CrossRefGoogle ScholarPubMed
Stout, RW (1990) Insulin and atheroma: 20-yr perspective. Diabetes Care 13, 631654.CrossRefGoogle ScholarPubMed
Swinburn, BA, Boyce, VL, Bergman, RN, Howard, BV & Bogardus, C (1991) Deterioration in carbohydate metabolism and lipoprotein changes induced by modern, high fat diet in Pima Indians and Caucasians. Journal of Clinical Endocrinology and Metabolism 73, 156165.CrossRefGoogle Scholar
UK Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352, 837853.CrossRefGoogle Scholar
US Department of Agriculture (1990) Dietary Guidelines for Americans, third ed. DHHS publication no. 273930. Washington, DC: U.S. Govt. Printing Office.Google Scholar
Weyer, C, Bogardus, C, Mott, DM & Pratley, RE (1999) The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. Journal of Clinical Investigation 104, 787794.CrossRefGoogle ScholarPubMed
Wolever, TMS, Bentum-Williams, A & Jenkins, DJA (1995) Physiologic modulation of plasma FFA concentrations by diet: metabolic implications in non-diabetic subjects. Diabetes Care 18, 962970.CrossRefGoogle Scholar
Wolever, TMS, Jenkins, DJA, Collier, GR, Lee, R, Wong, GS & Josse, RG (1988) Metabolic response to test meals containing different carbohydrate foods: 1. relationship between rate of digestion and plasma insulin response. Nutrition Research 8, 573581.CrossRefGoogle Scholar
Wolever, TMS, Jenkins, DJA, Jenkins, AL & Josse, RG (1991) The glycemic index: methodology and clinical implications. American Journal of Clinical Nutrition 54, 846854.CrossRefGoogle ScholarPubMed
World Health Organization (1980) WHO Expert Committee on Diabetes Mellitus. Second Report. pp. 814. Technical Report Series no. 646. Geneva: World Health Organization.Google Scholar
Zhou, Y-P & Grill, VE (1994) Long-term exposure of rat pancreatic islets to fatty acids inhibits glucose-induced insulin secretion and biosynthesis through a glucose fatty acid cycle. Journal of Clinical Investigation 93, 870876.CrossRefGoogle ScholarPubMed