August 23, 2018
2 min read

Food order affects glucose, insulin excursions in prediabetes

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Alpana P. Shukla 2018
Alpana P. Shukla

The order in which food is consumed during a meal subsequently affects blood glucose and insulin excursions in those with prediabetes, according to a study published in Diabetes, Obesity and Metabolism.

“Starting a meal with a salad or a salad and protein, and saving the carbs for the end, can lower postprandial glucose spikes, reduce glycemic variability and prevent reactive hypoglycemia,” Alpana P. Shukla, MD, MRCP, assistant professor of research in medicine in the division of endocrinology, diabetes and metabolism and director of clinical research at the Comprehensive Weight Control Center at Weill Cornell Medicine, told Endocrine Today. “Food order is a simple behavioral strategy that could serve as a diabetes prevention tool and can be implemented within diverse cultural settings and meal patterns.”

Researchers recruited 15 participants from Weill Cornell Medical College’s institutional research database after reviewing electronic medical records (11 women; four men; mean age, 52.4 years; mean BMI, 34.2 kg/m2; mean HbA1c, 6%).

Participants consumed the same meal on 3 days in three separate food-type orders: carbohydrate first over 10 minutes, a 10-minute rest interval and then protein and vegetables together over 10 minutes; protein and vegetables first over 10 minutes, a 10-minute rest interval and then carbohydrate over 10 minutes; or vegetables first over 10 minutes, a 10-minute rest interval and then protein and carbohydrate together over 10 minutes. Researchers took blood samples to measure glucose and insulin at 0, 30, 60, 90, 120, 150 and 180 minutes after the start of the meal.

Researchers found that, although all baseline fasting glucose concentrations were similar, glucose levels were decreased at 30 and 60 minutes after the protein and vegetable first order with the incremental area under the curve for glucose 38.8% lower than the carbohydrate first meal order (114.9 vs. 197.8 mmol/L x 180 minutes; P = .008).

The vegetable first meal order resulted in lower glucose levels at 30 and 60 minutes than the carbohydrate first meal order. In addition, there was a decrease in incremental AUC for glucose of 23.4%.

Mean glucose concentrations were lower in the carbohydrate first meal order than either the protein and vegetable first or the vegetable first meal orders at 120, 150 and 180 minutes.

Overall, the carbohydrate first meal pattern demonstrated marked glycemic variability, whereas glucose levels were stable in other meal conditions.

Researchers found that the vegetable first meal pattern reduced insulin excursions and that incremental AUC for insulin was 43.8% lower than for the carbohydrate first meal order.

“Controlling for calorie intake and macronutrient composition, nutrient order during a meal has a significant impact on postprandial glucose excursions in individuals with prediabetes,” Shukla said. “Further research is needed to assess the practical feasibility and effectiveness of this intervention in prospective studies. Our group has just started two pilot studies, one in gestational diabetes and the other in prediabetes, to assess these objectives.” – by Melissa J. Webb

For more information:

Alpana P. Shukla, MD, MRCP, can be reached at

Disclosure: The authors report no relevant financial disclosures.