Glycemic, insulinemic, and appetite responses of patients with type 2 diabetes to commonly consumed breads.

ABSTRACT

PURPOSE: The purpose of this study was to identify the breads most commonly consumed by adults with type 2 diabetes (T2DM) and then examine the postprandial glycemic, insulinemic, and appetite responses that these breads elicit. METHODS: One hundred people with T2DM were surveyed to identify the varieties of bread they most frequently consumed. According to a randomized crossover design, 11 fasting participants with T2DM consumed 50 g of available carbohydrate from 4 breads. Glucose and insulin concentrations and appetite ratings were determined over 270 minutes. RESULTS: Three commonly consumed varieties (white, whole wheat buttermilk, whole grain) identified in the survey-plus a lower-glycemic-index "control" bread (pumpernickel rye)-were tested in the second phase. Despite perceived differences between "brown" and "white" breads, the white, whole wheat buttermilk, and wholegrain breads promoted similar glycemic and insulinemic responses. Pumpernickel bread resulted in a significantly lower peak glucose (P < .01) than all other breads and a lower peak insulin (P < .001) than white or wholegrain bread. Similar appetite responses were found with all 4 breads. CONCLUSIONS: Adults with T2DM are choosing a variety of breads with perceived differential effects on glycemic, insulinemic, and appetite responses. Appreciable benefits, however, are not conferred by the commonly consumed breads. If breads known to promote favorable metabolic responses are unavailable, the primary emphasis in education should be placed on portion control. Conveying this information to patients is crucial if nutrition education is to achieve its aim of empowering individuals to manage their diabetes through their food choices.