Diet consistency modification improves postprandial glycemic and gastroparesis symptoms

Carolina C Betônico; Aline Vial Cobello; Daniele P Santos-Bezerra; André Z de A Leite; Maria Lúcia Correa-Giannella; Márcia Nery; Márcia S Queiroz

doi:10.1007/s40200-022-01117-w

Diet consistency modification improves postprandial glycemic and gastroparesis symptoms

J Diabetes Metab Disord. 2022 Sep 19;21(2):1661-1667. doi: 10.1007/s40200-022-01117-w. eCollection 2022 Dec.

Authors

Carolina C Betônico¹, Aline Vial Cobello², Daniele P Santos-Bezerra^{3

4}, André Z de A Leite⁵, Maria Lúcia Correa-Giannella^{3

4}, Márcia Nery⁶, Márcia S Queiroz⁷

Affiliations

¹ School of Medicine, UNIFAI-Faculdades Adamantinenses Integradas, Adamantina, São Paulo, Brazil.
² Nutrition and Dietetics Division, Central Institute of Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
³ Laboratory of Carbohydrates and Radioimmunoassays (LIM-18), Discipline of Endocrinology and Metabolism, Faculdade de Medicina, Universidade São Paulo, São Paulo, Brazil.
⁴ School of Medicine, São Paulo, SP Brazil.
⁵ Laboratory of Medical Investigation (LIM-07), Universidade de Sao Paulo Hospital das Clínicas Sao Paulo, São Paulo, Brazil.
⁶ Endocrinology Division, Internal Medicine Department, Hospital das Clinicas Faculdade de Medicina, Universidade São Paulo, São Paulo, Brazil.
⁷ Department of Graduation in Medicine, Universidade Nove de Julho (UNINOVE), Rua Vergueiro, 235/249 - Liberdade, São Paulo, SP 01525-000 Brazil.

Abstract

Abstract: Diabetic gastroparesis (DGP) is an autonomic neuropathy resulting from long-standing poorly controlled diabetes, and it is also linked to fluctuations in glycemic control due to variability on nutrient absorption.

Objectives: Considering the scarcity of information, the aim of this study was to identify the impact of modifications on diet consistency on post-prandial glucose variability using a continuous glucose monitoring (CGM) and its effect on the perception and severity of gastrointestinal symptoms.

Methods: This proof-of-concept study was carried out in a cross-sectional cohort of six individuals with type 1 diabetes mellitus with confirmed diagnosis of DGP. Two types of diet were used to evaluate glycemic control and DGP symptoms, general consistency standard meal (SD) and modified consistency test diet (MD), associated with an application of rapid acting insulin at the time of food intake. Glycemic control was evaluated by CGM, and the Gastroparesis Cardinal Symptom Index (GCSI) was applied after meals.

Results: The CGM curve was different for MD + insulin and SD + insulin. There was a smaller increment of interstitial glucose with 2 h after MD + insulin, returning almost to the basal level 4 h later. Patients scored significantly lower GCSI after MD + insulin compared to the same index after they received SD + insulin. Moreover, there was a decrease in important clinical scores present in the index, like: "Not able to finish meal", "Loss of appetite" and "Stomach or belly feels larger".

Conclusion: This study showed that a modified diet can improve postprandial glycemic excursion and the perception and severity of gastroparesis symptoms.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-022-01117-w.

Keywords: Continuous glucose monitoring; Diabetic gastroparesis; Diet consistency; Gastroparesis Cardinal Symptom Index; Glucose variability; Post-prandial glucose.

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