Eating vegetables before carbohydrates improves postprandial glucose excursions

Large fluctuations in blood glucose are reported to promote the microand macrovascular complications associated with Type 2 diabetes. Postprandial plasma glucose and glycaemic spikes are more strongly associated with atherosclerosis than fasting plasma glucose or HbA1c level [1]. Therefore, safe and effective interventions, including diet, are needed to reduce glycaemic variability and minimize hypoglycaemic events. The continuous glucose monitoring system is capable of detecting hypoglycaemia and hyperglycaemia that may be undetectable by self monitoring blood glucose and HbA1c [2]. In particular, the mean amplitude of glycaemic excursions is a significant determinant of overall metabolic control, as well as increased risk of diabetes complications. We reported acute effects of eating vegetables before carbohydrates on postprandial glucose and insulin levels [3] and the long-term glycaemic improvements in patients with Type 2 diabetes [4]. The method of the education included nutritional advice given in the form of a simple and easy meal plan of eating vegetables before carbohydrates. In order to reduce postprandial hyperglycaemia, patients were encouraged to consume every meal by eating vegetables prior to carbohydrates. In this study we evaluated whether eating vegetables before carbohydrates could reduce the daily postprandial glucose excursions assessed by continuous glucose monitoring system in Japanese patients with Type 2 diabetes and subjects with normal glucose tolerance. Consecutive patients with Type 2 diabetes were recruited among outpatients regularly attending a diabetes clinic, the Kajiyama Clinic located in Kyoto, Japan, from 2011 to 2012. Diagnosis of diabetes was made according to the World Health Organization criteria. Confirmation of normal glucose tolerance was based on fasting blood glucose