A randomized controlled trial of fruit meal sequence with low, moderate, and high glycemic indexes among type 2 diabetes mellitus patients

We aimed to study the low, moderate, and high glycemic indexes of fruit meal sequence among T2DM patients in Indonesia by measuring Fasting Blood Glucose (FBG) and insulin levels, Homeostasis model assessment of β-cell function (HOMA-β), and Dipeptidyl peptidase-4 (DPP4) activity. A randomized controlled trial (RCT), which included 48 participants, was conducted from November 2018 to March 2019. The meal sequence treatments were done in two intervals: 1–7 days fruit last meal (FL) and 14–21 days fruit first meal (FF). Significant differences in insulin and HOMA-β between control and low GI were observed in both intervals. However, no significant changes in Insulin level (5.16±3.47 vs. 5.51±6.16 μIU/ml, p=0.819) and HOMA-β (17.61±11.33 vs. 20.65±17.88, p=0.465) were observed from low GI in two different intervals. Our study clearly uncovered that low GI fruit consumption is beneficial in increasing insulin levels and HOMA-β but is independent of fruit meal sequence. Moderate and high GI fruits showed beneficial effects on insulin levels and HOMA-β only if consumed after the main meal. Although a significant decrease in FBG levels after 7 and 21 days was observed, the analysis on intervals (day 7-1 and 21-14) showed no changes in FBG levels after fruit sequence after or before meal. Further studies are needed to investigate the long-term effects of fruit meal sequence on glycemic parameters. This study provides evidence on how fruit meal sequence can directly affect the FBG level, insulin level, and HOMA-β. Given the essential effects of fruit meal sequence, this study gives insight into the integration of optimization of fiber intake from fruits and the meal sequence in T2DM management.