Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Carbohydrates, glycemic index and diabetes mellitus

Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes

European Journal of Clinical Nutrition volume 68, pages 459–463 (2014)Cite this article

Subjects

Abstract

Background/Objectives:

The aim was to investigate the associations of glycemic index (GI), glycemic load (GL), carbohydrate and fiber intakes with hyperglycemia in type 2 diabetic patients.

Subjects/Methods:

In a cross-sectional study of 640 type 2 diabetic patients aged 28–75 years, usual dietary intakes were assessed by validated food frequency questionnaire. We used published international and Iranian tables of GI based on the white bread. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI).

Results:

High-GL diet was associated with higher risk of hyperglycemia in type 2 diabetic patients after controlling for potential confounders. In multivariable model, OR (95% CI) for the highest vs the lowest quartile of GL was 2.58 (1.08–6.15) for elevated fasting serum glucose (FSG) (>130 mg/dl) (Ptrend=0.02) and was 3.05 (1.33–7.03) for elevated HbA1c (>8.6%) (Ptrend=0.008). After additional adjusting for dietary fiber and protein intakes, the relation of GL with elevated FSG and HbA1c was stable. GI was not significantly associated with either elevated FSG or HbA1c. In multivariable model, OR (95% CI) for the highest vs lowest quartile of the substitution of dietary carbohydrate for fat intake was 2.32 (1.37–3.92) for elevated HbA1c (Ptrend=0.001). Higher intake of dietary fiber was associated with lower risk of elevated FSG (highest vs lowest quartile: OR, 0.53; 95% CI: 0.28–0.99; Ptrend=0.04), but not with lower risk of elevated HbA1c.

Conclusions:

GL and carbohydrate intake were positively associated with the risk of hyperglycemia in type 2 diabetic patients; but the benefit in pursuing a low-GI diet without considering carbohydrate and energy intakes in these patients should be further investigated.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Marcovecchio ML, Lucantoni M, Chiarelli F . Role of chronic and acute hyperglycemia in the development of diabetes complications. Diabetes Technol Ther 2011; 13: 389–394.

    Article  CAS  Google Scholar 

  2. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013; 36: S11–S66.

    Article  Google Scholar 

  3. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014; 37: S14–S80.

    Article  Google Scholar 

  4. O'Dea K, Nestel PJ, Antonoff L . Physical factors influencing postprandial glucose and insulin responses to starch. Am J Clin Nutr 1980; 33: 760–765.

    Article  CAS  Google Scholar 

  5. Foster-Powell K, Holt SH, Brand-Miller JC . International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 2002; 76: 5–56.

    Article  CAS  Google Scholar 

  6. Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 1981; 34: 362–366.

    Article  CAS  Google Scholar 

  7. Liu S, Manson JE, Stampfer MJ, Holmes MD, Hu FB, Hankinson SE et al. Dietary glycemic load assessed by food-frequency questionnaire in relation to plasma high-density-lipoprotein cholesterol and fasting plasma triacylglycerols in postmenopausal women. Am J Clin Nutr 2001; 73: 560–566.

    Article  CAS  Google Scholar 

  8. Willett WC, Manson J, Liu S . Glycemic index, glycemic load, and risk of type 2 diabetes. Am J Clin Nutr 2002; 76: 274S–280S.

    Article  CAS  Google Scholar 

  9. Jenkins DJ, Kendall CW, McKeown-Eyssen G, Josse RG, Silverberg J, Booth GL et al. Effect of a low-glycemic index or a high-cereal fiber diet on type 2 diabetes: a randomized trial. JAMA 2008; 300: 2742–2753.

    Article  CAS  Google Scholar 

  10. Dong JY, Zhang L, Zhang YH, Qin LQ . Dietary glycaemic index and glycaemic load in relation to the risk of type 2 diabetes: a meta-analysis of prospective cohort studies. Br J Nutr 2011; 106: 1649–1654.

    Article  CAS  Google Scholar 

  11. Brand-Miller J, Hayne S, Petocz P, Colagiuri S . Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003; 26: 2261–2267.

    Article  Google Scholar 

  12. Riccardi G, Rivellese AA, Giacco R . Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr 2008; 87: 269S–274S.

    Article  CAS  Google Scholar 

  13. Ma Y, Olendzki BC, Merriam PA, Chiriboga DE, Culver AL, Li W et al. A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes. Nutrition 2008; 24: 45–56.

    Article  CAS  Google Scholar 

  14. Mayer-Davis EJ, Dhawan A, Liese AD, Teff K, Schulz M . Towards understanding of glycaemic index and glycaemic load in habitual diet: associations with measures of glycaemia in the Insulin Resistance Atherosclerosis Study. Br J Nutr 2006; 95: 397–405.

    Article  CAS  Google Scholar 

  15. The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes. Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr 2000; 54: 353–355.

    Article  Google Scholar 

  16. Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F . Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 2010; 13: 654–662.

    Article  Google Scholar 

  17. USDA Nutrient Database for Standard Reference, Release 24: Department of Agriculture ARS 2011.

  18. Levitan EB, Westgren CW, Liu S, Wolk A . Reproducibility and validity of dietary glycemic index, dietary glycemic load, and total carbohydrate intake in 141 Swedish men. Am J Clin Nutr 2007; 85: 548–553.

    Article  CAS  Google Scholar 

  19. Taleban FA, Esmaeili M . Glycemic Index of Iranian Foods. National Nutrition and Food Technology Research Institute Press: Tehran, Iran, 1999.

    Google Scholar 

  20. Wolever TM, Nguyen PM, Chiasson JL, Hunt JA, Josse RG, Palmason C et al. Determinants of diet glycemic index calculated retrospectively from diet records of 342 individuals with non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1994; 59: 1265–1269.

    Article  CAS  Google Scholar 

  21. Willett WC, Howe GR, Kushi LH . Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997; 65: 1220S–1228S.

    Article  CAS  Google Scholar 

  22. Glycated HbA1c. Chromatographic determination in tube with preweighted resin of hemoglobin A1c in blood. REF GD541500, GD540500. http://www.gdsrl.com/upload/prodotti/gd5415_00_glycated_hba1c_0.pdf.

  23. Hu FB, Stampfer MJ, Manson JE, Rimm E, Colditz GA, Rosner BA et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med 1997; 337: 1491–1499.

    Article  CAS  Google Scholar 

  24. van Aerde MA, Witte DR, Jeppesen C, Soedamah-Muthu SS, Bjerregaard P, Jørgensen ME . Glycemic index and glycemic load in relation to glucose intolerance among Greenland's Inuit population. Diabetes Res Clin Pract 2012; 97: 298–305.

    Article  CAS  Google Scholar 

  25. Du H, van der A DL, van Bakel MM, van der Kallen CJ, Blaak EE, van Greevenbroek MM et al. Glycemic index and glycemic load in relation to food and nutrient intake and metabolic risk factors in a Dutch population. Am J Clin Nutr 2008; 87: 655–661.

    Article  CAS  Google Scholar 

  26. Thomas DE, Elliott EJ . The use of low-glycaemic index diets in diabetes control. Br J Nutr 2010; 104: 797–802.

    Article  CAS  Google Scholar 

  27. Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr 2008; 87: 114–125.

    Article  CAS  Google Scholar 

  28. Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997; 20: 545–550.

    Article  Google Scholar 

  29. Krishnan S, Rosenberg L, Singer M, Hu FB, Djoussé L, Cupples LA et al. Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women. Arch Intern Med 2007; 167: 2304–2309.

    Article  Google Scholar 

  30. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC . Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997; 277: 472–477.

    Article  Google Scholar 

  31. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB . Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr 2004; 80: 348–356.

    Article  CAS  Google Scholar 

  32. Heilbronn LK, Noakes M, Clifton PM . Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes. Diabetes Care 1999; 22: 889–895.

    Article  CAS  Google Scholar 

  33. Post RE, Mainous 3rd AG, King DE, Simpson KN . Dietary fiber for the treatment of type 2 diabetes mellitus: a meta-analysis. J Am Board Fam Med 2012; 25: 16–23.

    Article  Google Scholar 

  34. Ciok J, Dolna A . The role of glycemic index concept in carbohydrate metabolism. Przegl Lek 2006; 63: 287–291.

    PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by a grant from the National Nutrition and Food Technology Research Institute, Tehran, Iran.

Author information

Authors and Affiliations

  1. Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam S Farvid, M Shokoohi & A Fallah

  2. Paramedical School, Jundishapur University of Medical Sciences and Health Services, Ahvaz, Iran

    F Homayouni

  3. Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Monir S Farvid

Authors
  1. Maryam S Farvid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Homayouni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Shokoohi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Fallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monir S Farvid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maryam S Farvid.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Farvid, M., Homayouni, F., Shokoohi, M. et al. Glycemic index, glycemic load and their association with glycemic control among patients with type 2 diabetes. Eur J Clin Nutr 68, 459–463 (2014). https://doi.org/10.1038/ejcn.2013.288

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.288

Keywords

This article is cited by

Search

Advanced search

Quick links