Prevalence of Idiopathic Reactive Hypoglycaemia and Impact of Fructo-Oligosaccharide Supplementation on Blood Glucose Variability
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BACKGROUND:The term idiopathic reactive hypoglycaemia (IRH) applies when a meal-induced dip in bloodglucose, or symptoms of hypoglycaemia, follows high-starch, low-fibre meals in otherwise healthyindividuals. Due to inconsistency of its definition and debated clinical value, reported prevalenceof this state varies. No consensus exists on optimal treatment of IRH, hence we wanted toinvestigate 1) the prevalence and characteristics of IRH, and 2) if diet supplementation of fibrecould improve the reactive glucose response in IRH.METHODS:362 subjects (71 + 9 years, 146 females), all previously undiagnosed of dysglycaemia, who hadparticipated in on of two case-control studies involving a oral glucose tolerance test (OGTT), wereclassified according to WHO standards (type 2 diabetes mellitus (T2DM), impaired glucosetolerance (IGT), normoglycaemia (NGT)) or categorized as IRH if OGTT 1h- or 2h- capillaryblood glucose (cBG) levels were ≤ 3.9 mmol/L or 1h- or 2h- glucose were < fasting cBG, with noevidence of T2DM or IGT. Characteristics of the IRH group were aligned with T2DM, IGT andNGT groups through a case-control evaluation of lipids, inflammatory- and IGF systemparameters, cardiovascular complications, medications and anthropometric measures.Further, twelve (56 + 8 years, 6 females) subjects from the IRH minority were recruited ina 4-week, randomized, crossover intervention, to evaluate the glucometabolic and anthropometriceffects of fructo-oligosaccharides (FOS), a dietary soluble fibre with texturising properties (10gbid for 2 weeks, no treatment the following 2 weeks). At the end of each 2-week treatmentsequence, fasting laboratory samples, a 4h-OGTT (blood glucose (BG) measures every 30thminute) and anthropometric measures were conducted.RESULTS:IRH was found in 12.4% of the subjects whom characteristics were: younger, a more favourableinflammatory- and IGF system axis profile and lower coronary artery disease (CAD) prevalence,compared to all other groups.FOS leveraged a significant improvement in several of the glucometabolic parameters.Although some fasting parameters were significantly reduced (plasma glucose and total cholesterol levels; 5.4 + 0.6 vs. 5.1 + 0.5 mmol/L, p < 0.05 and 5.3 + 1.1 vs. 4.9 + 1.1 mmol/L, p < 0.04,respectively), most benefits were seen in the 4h OGTT trajectory during the last two hours of the4h-OGTT. FOS significantly reduced glycaemic exposure (AUC) between 180 and 210 minutes (p= 0.03) and reduced the proportion of capillary blood glucose measurements < 3.9 mmol/L from21 to 11(χ2 = 4.26, p = 0.04) in this period. Moreover, favorable alternations in the shape of theOGTT curve were seen, with less pronounced zeniths and nadirs.CONCLUSION:A reactive hypoglycaemic response during an OGTT is prevalent in older adults and thisphenomenon could be modulated by dietary supplementation of FOS. The stabilizing effects offructo-oligosaccharides on blood glucose should be assessed in patient groups where BGvariability plays a role, e.g. in T1DM or T2DM.
Master i biomedisin
PublisherHøgskolen i Oslo. Avdeling for helsefag
Sykehuset Asker og Bærum