(Journal Article): Can the Glycemic Index (GI) be Used as a Tool in the Prevention and Management of Type 2 Diabetes?
 
Hermansen ML, Eriksen NM, Mortensen LS, Holm L, Hermansen K (Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus Sygehus THG, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark, kjeld.hermansen@as.aaa.dk )
 
IN: Rev Diabet Stud 2006; 3(2):61-71

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ABSTRACT: The large increase in type 2 diabetes (T2DM), the considerable lifetime risk of diabetes and the loss of lifetime call for concerted action to prevent T2DM and its complications. Since diabetes is characterized by abnormal glucose metabolism, the question arises of whether a high intake of carbohydrates that are rapidly absorbed as glucose may increase the risk and worsen the course of T2DM. To quantify the impact of carbohydrates on blood glucose the glycemic index (GI) and the glycemic load (GL) have been applied. The GI of a food is a method of ranking carbohydrate rich foods according to their glycemic responses. GI is defined as the incremental area under the blood glucose curve of 50g carbohydrate of a test food expressed as a percentage of the area of the response to an equivalent amount of a reference food (glucose or white bread). In relation to GI/GL and prevention of T2DM there is insufficient information from observational studies to determine whether a positive association exists or not. Only randomized controlled clinical intervention studies will be able to provide the final answer. From meta-analyses of randomised controlled clinical trials comparing low and high GI diets in the treatment of diabetes it has been found that low GI diets improve the glycemic control. Labeling of foods with GI would be helpful for persons with diabetes, but the usefulness for healthy subjects remains to be clarified. At present it seems premature to introduce GI labeling for the entire population.

TYPE OF PUBLICATION: Review

REFERENCES:

1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care 1998. 21:1414-1431.
2. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004. 27:1047-1053.
3. Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 2005. 365:1333-1346.
4. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA 2003. 290:1884-1890.
5. Glumer C, Jorgensen T, Borch-Johnsen K. Prevalence of diabetes and impaired glucose regulation in a Danish population: the Inter99 study. Diabetes Care 2003. 26:2335-2340.
6. Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM. Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ 2001. 322:1389-1393.
7. Colditz GA, Willett WC, Stampfer MJ, Manson JE, Hennekens CH, Arky RA, Speizer FE. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990. 132:501-513.
8. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997. 20:537-544.
9. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Finnish Diabetes Prevention Study Group. N Engl J Med 2001. 344:1343-1350.
10. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Diabetes Prevention program Research Group. N Engl J Med 2002. 346:393-403.
11. 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. 34:362-366.
12. Food and Agriculture Organization. Carbohydrates in human nutrition: report of a joint FAO/WHO expert consultation. FAO Food Nutr Pap 1998. 66:1-140.
13. Wolever TM, Vorster HH, Bjorck I, Brand-Miller J, Brighenti F, Mann JI, Ramdath DD, Granfeldt Y, Holt S, Perry TL, Venter C, Xiaomei Wu. Determination of the glycaemic index of foods: interlaboratory study. Eur J Clin Nutr 2003. 57:475-482.
14. Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values 2002. Am J Clin Nutr 2002. 76:5-56.
15. Henry CJ, Lightowler HJ, Strik CM, Renton H, Hails S. Glycaemic index and glycaemic load values of commercially available products in the UK. Br J Nutr 2005. 94:922-930.
16. Rasmussen O, Gregersen S, Dorup J, Hermansen K. Day-to-day variation of blood glucose and insulin responses in NIDDM subjects after starch-rich meal. Diabetes Care 1992. 4:522-524.
17. Wolever TM, Nuttall FQ, Lee R, Wong GS, Josse RG, Csima A, Jenkins DJ. Prediction of the relative blood glucose response of mixed meals using the white bread glycemic index. Diabetes Care 1985. 8:418-428.
18. Hermansen K. Research methodologies in the evaluation of intestinal glucose absorption and the concept of glycemic index. In: Mogensen CE, Standl E, Gruyter, et al (ed). Research Methodologies in Human Diabetes, Berlin-New York, 1994. Part 1, pp 205-218.
19. Wolever TM, Bolognesi C. Source and amount of carbohydrate affect postprandial glucose and insulin in normal subject. J Nutr 1996. 126:2798-2806.
20. Brand JC, Nicholson PL, Thorburn AW, Truswell AS. Food processing and the glycemic index. Am J Clin Nutr 1985. 42:1192-1196.
21. Rasmussen OW. Nutrition and diabetes mellitus: Influence of carbohydrate and monosaturated fat on the intermediary metabolism. Thesis. University of Aarhus 1997. pp 1-74.
22. Bjorck I, Liljeberg H, Ostman E. Low glycaemic-index foods. Br J Nutr 2000. 83:149-155.
23. Frid AH, Nilsson M, Holst JJ, Bjorck IM. Effect of whey on blood glucose and insulin responses to composite breakfast and lunch meals in type 2 diabetic subjects. Am J Clin Nutr 2005. 82:69-75.
24. Larsen HN, Christensen C, Rasmussen OW, Tetens IH, Choudhury NH, Thilsted SH, Hermansen K. Influence of parboiling and physico-chemical characteristics of rice on the glycaemic index in non-insulin-dependent diabetic subjects. Eur J Clin Nutr 1996. 50:22-27.
25. Hermansen K, Rasmussen O, Gregersen S, Larsen S. Influence of ripeness of banana on the blood glucose and insulin response in type 2 diabetic subjects. Diabetic Medicine 1992. 9:739-743.
26. Wolever TM, Jenkins DJ, Ocana AM, Rao VA, Collier GR. Second-meal effect: low-glycemic-index foods eaten at dinner improve subsequent breakfast glycemic response. Am J Clin Nutr 1988. 48:1041-1047.
27. Bertelsen J, Christiansen C, Thomsen C, Poulsen PL, Vestergaard S, Steinov A, Rasmussen LH, Rasmussen O, Hermansen K. Effect of meal frequency on blood glucose, insulin, and free fatty acids in NIDDM subjects. Diabetes Care 1993. 16:4-7.
28. Salmeron J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997. 277:472-477.
29. Salmeron J, Ascheiro A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, Stampfer MJ, Wing AL, Willet WC. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997. 20:545-550.
30. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 2004. 80:348-356.
31. Hodge AM, English DR, O'Dea K, Giles GG. Glycemic index and dietary fiber and the risk of type 2 diabetes. Diabetes Care 2004. 27:2701-2706.
32. Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 2000. 71:921-930.
33. Stevens J, Ahn K, Juhaeri, Houston D, Steffan L, Couper D. Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the Aric study. Diabetes Care 2002. 25:1715-1721.
34. Colditz GA, Manson JE, Hankinson SE. The Nurses' Health Study: 20-year contribution to the understanding of health among women. J Womens Health 1997. 6:49-62.
35. Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol 1985. 122:51-65.
36. Willett WC. Nutritional Epidemiology. 2nd ed. Oxford University Press, New York, 1998.
37. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001. 345:790-797.
38. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979. 28:1039-1057.
39. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J Med 1993. 329:977-986.
40. UK Prospective Diabetes Study (UKPDS) Group. 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 1998. 352:837-853
41. Turner RC, Millns H, Neil HA, Stratton IM, Manley SE, Matthews DR, Holman RR. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23). BMJ 1998. 316:823-828.
42. Tahara Y, Shima K. Kinetics of HbA1c, glycated albumin, and fructosamine and analysis of their weight functions against preceding plasma glucose level 1. Diabetes Care 1995. 18:440-447.
43. Bischoff H. The mechanism of alpha-glycosidase inhibition in the management of diabetes. Clin Invest Med 1995. 18:303-311.
44. Coniff RF, Shapiro JA, Robbins D, Kleinfield R, Seaton TB, Beisswenger P, McGill JB. Reduction of glycosylated hemoglobin and postprandial hyperglycemia by acarbose in patients with NIDDM. A placebo-controlled dose-comparison study. Diabetes Care 1995. 18:817-824.
45. Brand-Miller JC, Thomas M, Swan V, Ahmad ZI, Petocz P, Colagiuri S. Physiological validation of the concept of glycemic load in lean young adults. J Nutr 2003. 133:2728-2732.
46. Hollenbeck CB, Coulston AM. The clinical utility of the glycemic index and its application to mixed meals. Can J Physiol Pharmacol 1991. 69:100-107.
47. Jarvi AE, Karlstrom BE, Granfeldt YE, Bjorck IE, Asp NG, Vessby BO. Improved glycemic control and lipid profile and normalized fibrinolytic activity on a low GI diet in type 2 diabetic patients. Diabetic Care 1999. 22:16-18.
48. 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 diabetec men. Diabetes Care 2004. 27:1866-1872.
49. Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values. Am J Clin Nutr 2002. 76:5-56.
50. 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. 26:2261-2267.
51. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial blood glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients. Diabetes Care 2003. 26:881-885.
52. Fontville A, Rizkalla S, Penfornis A, Acosta M, Bornet F, Slama G. The use of low glycemic index foods improves metabolic control of diabetic patients over five weeks. Diabet Med 1992. 9:444-450.
53. Komindr S, Ingsriswang S, Lerdvuthisopon N, Boontawee A. Effect of long-term intake of Asien food with different glycemic indices on diabetic control and protein conservation in type 2 diabetic patients. J Med Assoc Thai 2001. 84:85-97.
54. Luscombe N, Noakes M, Clifton P. Diets high and low in glycemic index versus high monounsaturated fat diets: effects on glucose and lipid metabolism in NIDDM. Eur J Clin Nutr 1999. 53: 473-478.
55. Frost G, Wilding J, Beecham J. Dietary advice based on the glycaemic index improves dietary profile and metabolic control in type 2 diabetic patients. Diabet Med 1994. 11:397-401.
56. Wolever T, Jenkins D, Vuksan V, Jenkins A, Buckley G, Wong G, Josse RG. Beneficial effect of a low glycemic index diet in type 2 diabetes. Diab Med 1992. 9:451-458.
57. Wolever T, Jenkins D, Vuksan V, Jenkins A, Wong G, Josse R. Beneficial effect of low-glycemic index diet in overweight NIDDM subjects. Diabetes Care 1992. 15:562-564.
58. Brand J, Colagiuri S, Crossman S, Allen A, Robert D, Truswell A. Low-glycemic index foods improve long-term glycemic control in NIDDM. Diabetes Care 1991. 14:95-101.
59. Jenkins DJ, Wolever TM, Buckley G, Lam KY, Giudici S, Kalmusky J, Jenkins AL, Patten RL, Bird J, Wong GS, et al. Low glycemic-index starchy foods in the diabetic diet. Am J Clin Nutr 1988. 48:248-254.
60. Mann J. Meta-analysis of low-glycemic index diets in the management of diabetes. Response to Franz. Diabetes Care 2003. 26:3364.
61. Franz MJ. The Glycemic Index. Not the most effective nutrition therapy intervention. Diabetes Care 2004. 26:2466-2468.
62. Opperman AM, Venter CS, Oosthuizen W, Thompson RL, Vorster HH. Meta-analysis of the health effects of using the glycemic index in meal-planning. Br J Nutr 2004. 92:367-381.
63. Tsihlias EB, Gibbs AL, McBurney MI, Wolever TM. Comparison of high- and low-glycemic-index breakfast cereals with monounsaturated fat in the long-term dietary management of type 2 diabetes. Am J Clin Nutr 2000. 72:439-449.
64. American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications, position statement. Diabetes Care 2002. 25:202-212.
65. American Diabetes Association. Dietary Carbohydrate (amount and type) in the prevention and management of diabetes. Diabetes Care 2004. 27:2266-2271.
66. Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 2004. 14:373-394.
67. http://www. healthyeatingclub.com/info/articles/diseases/GIsymbol.htm.
68. Raben A, Hermansen K. Health aspects of mono- and disaccharides in Carbohydrates in food. In: Eliasson AC (ed). CRC Press, Taylor and Francis Group, Boca Raton, London, New York, Second edition 2006. pp 89-127.
69. Joint WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of Chronic Diseases. World Health Organ Tech Rep Ser 2003. 916:1-149.