The effect of small doses of fructose and allulose on postprandial glucose metabolism in type 2 diabetes: A double-blind,randomized,controlled,acute feeding,equivalence trial
Jarvis C. Noronha,Catherine R. Braunstein,Andrea J. Glenn,Tauseef A. Khan,Effie Viguiliouk,Rebecca Noseworthy,Sonia Blanco Mejia,Cyril W. C. Kendall,Thomas M.S.Wolever,Lawrence A. Leiter,John L. Sievenpiper,et al.
Diabetes Obes Metab. 2018;20:2361–2370.
Aim: To assess and compare the effect of small doses of fructose and allulose on postprandial blood glucose regulation in type 2 diabetes.
Methods: A double-blind, multiple-crossover, randomized, controlled, acute feeding, equivalence trial in 24 participants with type 2 diabetes was conducted. Each participant was randomly assigned six treatments separated by ≥1-week washouts. Treatments consisted of fructose or allulose at 0 g (control), 5 g or 10 g added to a 75-g glucose solution. A standard 75-g oral glucose tolerance test protocol was followed with blood samples at −30, 0, 30, 60, 90 and 120 minutes. The primary outcome measure was plasma glucose incremental area under the curve (iAUC).
Results: Allulose significantly reduced plasma glucose iAUC by 8% at 10 g compared with 0 g(717.4±38.3 vs. 777.5±39.9 mmol × min/L, P = 0.015) with a linear dose response gradient between the reduction in plasma glucose iAUC and dose (P = 0.016). Allulose also significantly reduced several related secondary and exploratory outcome measures at 5 g (plasma glucose absolute mean and total AUC) and 10 g (plasma glucose absolute mean, absolute and incremental maximum concentration [Cmax], and total AUC) (P < 0.0125). There was no effect of fructose at any dose. Although allulose showed statistically significant reductions in plasma glucose iAUC compared with fructose at 5 g, 10 g and pooled doses, these reductions were within the prespecified equivalence margins of ±20%.
Conclusion: Allulose, but not fructose, led to modest reductions in the postprandial blood glucose response to oral glucose in individuals with type 2 diabetes. There is a need for long-term randomized trials to confirm the sustainability of these improvements.
Keywords:clinical trial, dietary intervention, dose–response relationship, glucose, metabolism, type 2 diabetes, randomized trial