Meal Order for Diabetes

Overseen By Patrick Wilson, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Old Dominion University

Disqualifiers: Cardiovascular disease, Diabetes, Pulmonary disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 1 day per condition

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how the order of eating different foods during a meal affects blood sugar levels and exercise performance. Participants will try two meal sequences: consuming carbohydrate-rich foods either first or last, followed by exercise an hour later. The goal is to assess how these meal orders impact blood sugar levels, energy use, and participants' feelings during and after exercising. Suitable candidates are those who already exercise regularly and can run for at least 30 minutes. As an unphased trial, this study provides a unique opportunity to contribute to understanding how meal timing can optimize exercise and health.

Do I need to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this meal order technique is safe for diabetes patients?

Research has shown that the order of food consumption during a meal can affect blood sugar levels. Eating carbohydrates last, after vegetables and proteins, can help reduce blood sugar spikes in individuals with and without diabetes. This method is safe and offers an easy way to improve diet.

Conversely, consuming carbohydrates first can lead to higher blood sugar levels. While not necessarily harmful, it may not control blood sugar as effectively as eating carbs last.

Both eating methods are generally well-tolerated, with no serious side effects reported. The trial aims to understand how these meal orders affect exercise and does not involve any new or untested drugs, minimizing safety concerns. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how the order of eating different food groups might affect blood sugar levels in people with diabetes. Unlike traditional treatments that focus on medication or insulin management, this approach investigates whether eating carbohydrates last, after other food groups, could help control blood sugar spikes. This method is non-invasive and could provide a simple, everyday strategy to better manage diabetes alongside existing treatments.

What evidence suggests that this meal order technique is effective for managing postprandial glucose in diabetes?

Research has shown that eating carbohydrates at the end of a meal, rather than at the beginning, can significantly lower post-meal blood sugar levels for people with type 2 diabetes. In this trial, participants will follow different meal orders to test this effect. One study found that when participants ate carbohydrates last, blood sugar levels dropped by about 5.87% after an hour. Another study demonstrated that this meal order also reduced insulin levels, aiding diabetes management. Conversely, starting a meal with carbohydrates can lead to higher blood sugar spikes. Eating vegetables and proteins first slows the entry of sugar into the bloodstream, making the practice of eating carbohydrates last a promising strategy for improving blood sugar control. ^{2 6 7 8 9}

Who Is on the Research Team?

Patrick Wilson

Principal Investigator

Old Dominion University

Are You a Good Fit for This Trial?

This trial is for physically active individuals who can run at a moderate-to-high intensity for at least 30 minutes. Participants should have been exercising regularly, at least three times a week for the past three months.

Inclusion Criteria

Currently physically active (scheduled exercise at least three days per week for 30 minutes each time over the last three months)

Ability to perform moderate-to-high intensity running for at least 30 minutes

Exclusion Criteria

Currently pregnant

Any allergy or other condition that would prohibit the consumption of poultry, rice, or broccoli

Implanted electrical devices such as a pacemaker.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants undergo two acute feeding conditions (carbohydrate-rich foods first vs. last in a meal), followed by exercise 60 minutes later

1 day per condition

2 visits (in-person)

Follow-up

Participants are monitored for postprandial glucose, substrate/fuel utilization, and subjective perceptions at rest and during exercise

2 hours per visit

What Are the Treatments Tested in This Trial?

Interventions

• Ordered Eating

Trial Overview The study tests how eating carbohydrates either at the beginning or end of a meal affects blood sugar levels and exercise response. Each participant will try both eating orders followed by exercise an hour later to see which method is better for managing glucose during physical activity.

How Is the Trial Designed?

Group I: Carbohydrate-last meal Experimental Treatment 1 Intervention

Group II: Carbohydrate-first meal Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Old Dominion University

Lead Sponsor

Trials

25

Recruited

15,500+

Published Research Related to This Trial

The Exchange Lists for Meal Planning, used for over 50 years by individuals with diabetes and those on weight-loss diets, are supported by a comprehensive database that details the energy and macronutrient values of various foods.

The analysis of this database shows that while the average values for food groups align with the Exchange Lists, there is significant variability, which can inform clinical decision-making in meal planning and food labeling.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Macronutrient and energy database for the 1995 Exchange Lists for Meal Planning: a rationale for clinical practice decisions. Wheeler, ML., Franz, M., Barrier, P., et al.[2015]

In a study of 167 hospitalized patients on therapeutic diets, meal-related errors were found in 8% of the 906 meals assessed, with 97% of these errors classified as critical, highlighting significant safety risks.

The implementation of an electronic foodservice system (EFS) nearly eliminated errors during meal assembly, but critical errors were still prevalent during menu planning and meal delivery, indicating that further improvements are needed in these areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying errors in meals provided to and sourced by patients on therapeutic diets in hospital. Rattray, M., Desbrow, B., Roberts, S.[2019]

The study found an average tray assembly error rate of 12.9% across 6,553 trays, with the highest errors occurring during evening meals and in the second half of the assembly period.

Only 2.7% of the errors were critical, meaning they contradicted diet orders, indicating that while errors are common, most do not severely impact patient nutrition care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Monitor of tray error rates for quality control. Dowling, RA., Cotner, CG.[2000]

Youth with type 1 diabetes showed poorer diet quality on weekends compared to weekdays, with increased energy intake and lower consumption of fruits and vegetables, highlighting the need for targeted nutrition education.

Meals consumed at home generally had better nutrient density than those eaten away from home, particularly for breakfast and dinner, suggesting that meal location significantly impacts dietary quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contextual factors are associated with diet quality in youth with type 1 diabetes mellitus. Nansel, TR., Lipsky, LM., Liu, A., et al.[2021]

A new computer program has been created to help diabetic patients by generating personalized meal plans based on their dietary needs, meal patterns, and food preferences.

The program not only produces daily menus that vary each day but also provides nutrient summaries and shopping lists, making it a comprehensive tool for managing diabetes through diet.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computer-planned menus for patients with diabetes mellitus. Wheeler, ML., Wheeler, LA.[2019]

The revised Exchange List for Meal Planning emphasizes a high-carbohydrate, high-fiber diet for individuals with diabetes, reflecting updated nutritional recommendations and improving educational utility.

A new simplified meal planning tool, Healthy Food Choices, was developed to aid in initial education, grouping foods by calories and allowing nutrition counselors to customize meal plans for clients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exchange lists: revised 1986. Franz, MJ., Barr, P., Holler, H., et al.[2009]

In a study involving 163 hospitalized children, a revised menu with child-friendly labeling significantly increased the selection of healthier 'green-light' food options and reduced 'red-light' items at the first meal.

While the labeling encouraged healthier choices initially, the positive effects diminished over time, indicating that ongoing strategies may be needed to maintain healthy eating habits in children during hospitalization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals? Basak, S., Steinberg, A., Campbell, A., et al.[2019]

The novel FoodforCare meal service significantly improved protein and energy intake among patients compared to the traditional meal service, with notable increases in intake on both the first and fourth days of full oral intake.

Patient satisfaction with the meal service remained stable, but the FoodforCare group reported better satisfaction regarding the appearance and smell of the meals, indicating a positive reception of the new service.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A novel in-hospital meal service improves protein and energy intake]. Dijxhoorn, DN., van den Berg, MGA., Drenth, JPH., et al.[2018]

In a study of 126 hospitalized patients with type 2 diabetes, a flexible meal dosing strategy resulted in similar glucose control compared to a fixed meal dosing strategy, with mean glucose levels of 8.8 mmol/L for flexible dosing and 9.5 mmol/L for fixed dosing.

The flexible meal group experienced a higher frequency of hypoglycemia (39%) compared to the fixed meal group (23%), although this difference was not statistically significant, indicating a need for further research to optimize insulin delivery in hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes. Dungan, KM., Sagrilla, C., Abdel-Rasoul, M., et al.[2021]

A computerized order set for managing diabetes in hospitalized patients improved glycemic control, with 75% of glucose readings in the target range (60-180 mg/dL) compared to 71% in usual care, based on a study of 179 patients.

The intervention group also showed a lower average glucose level (148 mg/dL vs. 158 mg/dL) and reduced reliance on sliding-scale insulin, while maintaining a similar rate of severe hypoglycemia, indicating safety in the new approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a computerized order set on the inpatient management of hyperglycemia: a cluster-randomized controlled trial. Schnipper, JL., Liang, CL., Ndumele, CD., et al.[2022]

In a study of 77 patients with type 2 diabetes over 12 months, a diabetic meal delivery system significantly reduced HbA1c levels from 8.2% to 7.4%, demonstrating its effectiveness in improving glycemic control.

The diabetic meal delivery system was found to be as effective as individual dietary counseling, suggesting it can be a viable option for diabetes management and education in outpatient settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention with delivery of diabetic meals improves glycemic control in patients with type 2 diabetes mellitus. Imai, S., Kozai, H., Matsuda, M., et al.[2022]

A systematic review of five studies involving 720 patients found that electronic bedside meal ordering systems significantly improved patient dietary intake, satisfaction, and reduced plate waste compared to traditional menu systems.

Despite these positive outcomes, the review highlights a need for more research to fully understand the impact of these digital systems on patient and organizational outcomes in hospital foodservices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of electronic bedside meal ordering systems on dietary intake, patient satisfaction, plate waste and costs: A systematic literature review. MacKenzie-Shalders, K., Maunder, K., So, D., et al.[2020]

Dividing a breakfast into two portions significantly improved blood glucose levels in mild diabetic patients, especially when the first portion was high in protein.

This high-protein meal division not only improved blood glucose responses but also brought the insulin response of diabetic patients closer to that of normal subjects, suggesting that protein-rich meals may be beneficial for managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blood glucose and plasma insulin of mild diabetic patients in response to high protein divided meals. Seino, Y., Ikeda, M., Taminato, T., et al.[2011]

The paper presents six alternative meal-planning approaches for individuals with diabetes, emphasizing the importance of personalized nutrition education beyond traditional exchange lists.

These approaches, including High Carbohydrate-High Fiber Exchange System and Calorie/Fat Counting, are evaluated based on their effectiveness for weight loss, glucose control, and ease of learning, providing a comprehensive resource for tailored dietary management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Alternatives to the exchange system for teaching meal planning to persons with diabetes. Pastors, JG.[2017]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8883221/

Efficacy of a meal sequence in patients with type 2 diabetes This systematic review investigated the efficacy of a meal sequence, the carbohydrate-later meal pattern (CL), on type 2 diabetes mellitus (T2DM).

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5604719/

Carbohydrate-last meal pattern lowers postprandial ... The carbohydrate-last meal pattern may be an effective behavioral strategy to improve postprandial glucose control in patients with type 2 ...

3. frontiersin.org frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1512231/full

Food order affects blood glucose and insulin levels ... This study demonstrates that consuming vegetables first, followed by proteins, and carbohydrates last, significantly enhances glycemic control ...

4. theeducatedpatient.com theeducatedpatient.com/view/the-order-of-eating-how-it-impacts-blood-sugar-for-people-with-diabetes

The Order of Eating: How It Impacts Blood Sugar for People ... For improved blood sugar control, it's recommended to eat your food in the following order: Fiber first: Start your meal with nonstarchy ...

5. nature.com nature.com/articles/nutd201633

Manipulating the sequence of food ingestion improves ... We tested feasibility, safety and clinical efficacy of manipulating the sequence of nutrient ingestion in patients with type 2 diabetes (T2D).

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7551485/

A Review of Recent Findings on Meal Sequence Preloading protein or fat before carbohydrate increased GLP-1 secretion and ameliorated postprandial hyperglycemia; however, intake of several ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4876745/

Food Order Has a Significant Impact on Postprandial ... In this pilot study, we demonstrated that the temporal sequence of carbohydrate ingestion during a meal has a significant impact on postprandial glucose and ...

8. mdpi.com mdpi.com/2072-6643/15/20/4452

A Randomized Controlled Pilot Study of the Food Order ... In conclusion, carbohydrate-last food order is a feasible behavioral strategy that can be implemented by individuals with prediabetes.

9. drc.bmj.com drc.bmj.com/content/10/1/e002534

Efficacy of a meal sequence in patients with type 2 diabetes Regarding primary outcomes, carbohydrate-later meal patterns may result in a slight to no difference in HbA1c after 2 months to 2 years.