PracticeUpdate: Endocrinology | Volume 1. No 3. 2016

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Awhey/guar “preload” improves postprandial glycaemia
and HbA in type 2 diabetes
In well controlled patients with type 2 diabetes, 12 weeks’ treatment with a low dose whey/guar preload taken twice daily
before meals has been shown to reduce postprandial blood glucose.
This outcome of a 12-week,
single-blind, randomised,
placebo-controlled trial was
reported at the EASD 2016 meeting.
Chris K. Rayner, PhD, of the
University of Adelaide, Australia,
explained that his team has shown
that whey “preloads,” taken before
meals for up to 4 weeks, slow gastric
emptying and reduce postprandial
glycaemia in type 2 diabetes. Guar
also slows carbohydrate absorp-
tion. Dr Rayner and colleagues
evaluated the effects of 12 weeks’
treatment with a whey/guar preload
on gastric emptying, postprandial
blood glucose, and overall glycaemic
control (haemoglobinA1c), in type 2
diabetes.
Forty-seven patients with type 2
diabetes (26 males; age 64 ± 7 years
of age; body mass index 29.5 ±
5.1 kg/m2; haemoglobin A1c 6.5
± 0.5%; 24 managed by diet alone
and 23 by metformin) received
150 mL flavoured shakes contain-
ing either 20 g whey protein and 5 g
guar (90 kcal), or flavoured placebo
(0 kcal), 15 minutes before two
meals each day, for 12 weeks. No
other specific dietary advice was
given.
During the first day (week 1) and
last day (week 12) of treatment, pa-
tients attended the laboratory after
an overnight fast and consumed the
whey/guar or placebo preload shake
15 minutes before a mashed potato
meal (368.5kcal: 61.4 g carbohy-
drate, 7.4 g protein, and 8.9 g fat)
labelled with 13C-octanoic acid.
Venous blood was sampled
frequently for measurement of glu-
cose, and gastric 50% emptying time
was calculated by quantifying breath
13C over 240 minutes. Haemoglo-
bin A1c was measured on the first
and last day of treatment.
Gastric emptying was slower after
the whey/guar preload than after pla-
cebo at the beginning of treatment
(gastric 50% emptying time: whey/
guar 192.4 ± 9.2 minutes, placebo
167.2 ± 7.2 minutes, P < 0.05),
though this effect was attenuated
after 12 weeks (gastric 50% emp-
tying time: whey/guar 177.2 ± 8.6
minutes, placebo 163.7 ± 7.5 min-
utes, difference not significant).
Postprandial blood glucose concen-
trations were lower after the whey/
guar preload than after placebo at both
the beginning (P < 0.0001) and end
(P< 0.0001) of treatment, without any
attenuation of this effect at 12 weeks.
During both week 1 (r = –0.58, P =
0.0001) and week 12 (r = –0.57, P =
0.0001) an inverse relationship was
observed between blood glucose at 60
minutes and gastric 50% emptying,
so that when gastric emptying was
more relatively rapid, the glycaemic
response was greater.
Haemoglobin A1c decreased
by 0.1 ± 0.1% (1.0 ± 0.6 mmol/
mol) with the whey/guar preload
and increased by 0.2 ± 0.1% (2.0
± 0.8 mmol/mol) with placebo
(P = 0.005). No meaningful changes
in body weight were observed in ei-
ther group (placebo –0.4 ± 0.3 kg,
whey/guar –0.4 ± 0.3 kg).
Dr Rayner concluded that in
well controlled patients with type
2 diabetes, 12 weeks’ treatment
with a low-dose whey/guar preload
taken twice daily before meals was
shown to reduce postprandial blood
glucose, was associated with a slow-
ing of gastric emptying, and led to a
modest improvement in haemoglo-
bin A1c.
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Whey “preloads,” taken
before meals for up to
4 weeks, slow gastric
emptying and reduce
postprandial glycaemia in
type 2 diabetes. Guar also
slows carbohydrate
absorption.
Courtesy of EASD 2016
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VOL. 1 • No. 3 • 2016
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