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Both Dietary Protein and Fat Increase Postprandial Glucose Excursions in Children With Type 1 Diabetes, and the Effect Is Additive Featured Article: Carmel E.M. Smart, R.D., P.H.D., Megan Evans, R.D., PGRADDIPDIET, Susan M. OConnell, M.D., F.R.A.C.P., Patrick McElduff, P.H.D., Prudence E. Lopez, M.D., Timothy W. Jones, M.D., F.R.A.C.P., Elizabeth A. Davis, M.D., P.H.D., Bruce R. King, M.D., P.H.D. Diabetes Care Volume 36: 3897-3902 December, 2013

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STUDY OBJECTIVE To determine the effects of high-protein (HP) and high-fat (HF) meals on postprandial glycemia in children using intensive insulin therapy (IIT) Smart C. E.M. et al. Diabetes Care 2013;36:3897-3902

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STUDY DESIGN AND METHODS 33 subjects aged 817 years were given four test breakfasts with the same carbohydrate amount but varying protein and fat quantities: Low fat (LF)/low protein (LP) LF/HP HF/LP HF/HP Smart C. E.M. et al. Diabetes Care 2013;36:3897-3902

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STUDY DESIGN AND METHODS LF and HF meals contained 4 and 35 g fat, respectively LP and HP meals contained 5 and 40 g protein, respectively An individually standardized insulin dose was given for each meal Postprandial glycemia was assessed by 5-h continuous glucose monitoring Smart C. E.M. et al. Diabetes Care 2013;36:3897-3902

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RESULTS Compared with the LF/LP meal, mean glucose excursions were greater from 180 min after the LF/HP meal and from 210 min after the HF/LP meal HF/HP meal resulted in higher glucose excursions from 180 to 300 min Reduction in the risk of hypoglycemia occurred after the HP meals Smart C. E.M. et al. Diabetes Care 2013;36:3897-3902

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CONCLUSIONS Meals high in protein or fat increase glucose excursions from 3 to 5 h postmeal Protein and fat have an additive impact on the delayed postprandial glycemic rise Protein had a protective effect on the development of hypoglycemia Smart C. E.M. et al. Diabetes Care 2013;36:3897-3902

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