European Journal of Nutrition

, Volume 56, Issue 3, pp 1359–1367 | Cite as

Postprandial glucose and insulin levels in type 2 diabetes mellitus patients after consumption of ready-to-eat mixed meals

  • Yannis ManiosEmail author
  • George Moschonis
  • Christina Mavrogianni
  • Konstantina Tsoutsoulopoulou
  • Stergios Kogkas
  • Christina-Paulina Lambrinou
  • Eirini Efstathopoulou
Original Contribution



To compare the effects of three ready-to-eat mixed meals, with a high fiber content and low glycemic index, on postprandial glycemic and insulinemic response in patients with Type 2 diabetes mellitus (T2DM).


The current study followed a prospective, three-way, cross-over design. Twenty-four patients with T2DM consumed three ready-to-eat mixed meals, i.e., “wild greens pie” (meal 1), “chicken burgers with boiled vegetables” (meal 2) and “vegetable moussaka” (meal 3) and an oral glucose load, all providing 50 g of carbohydrates. Venous blood was collected at 0, 30, 60, 90 and 120 min postprandial. Statistical analyses included repeated measures analysis of variance and calculations of the area under the glucose and insulin curves (AUC) for each one of the test meals and the oral glucose load.


Patients consuming each one of the three mixed meals showed better postprandial glycemic responses compared to the oral glucose load (P < 0.001). Furthermore, patients consuming meal 3 showed a better insulinemic response compared to the oral glucose load and meal 1, after 60 and 120 min postprandial, respectively (P < 0.05). In addition, the increase observed in HOMA-IR values from T0 to T120 was significantly lower for meal 3, compared to the oral glucose load (P < 0.001).


The three ready-to-eat mixed meals examined in the present study were found to elicit significantly lower glycemic responses compared to the oral glucose load in diabetic patients. The mixed meals examined in the present study could be proposed as effective, palatable and practical solutions for diabetics for glucose control.


Diabetes Glycemic response Insulinemic response Mixed meals Glycemic index 



The authors would like to thank “Sunday’s Catering-Steniotis Bros Ltd” company for manufacturing and providing the examined ready-to-eat meals, under the commercial name “Taste Control Diabetes”. The authors are also indebted to all research team members that contributed to the study execution: Eftychia Apostolidou, Antigoni Tsiafitsa, Konstantina Maragkopoulou, Eleni Avlichou, Athanasios Douligeris, as well as all study participants.

Author’s contribution

YM and GM prepared the study design. YM, GM and CM performed the statistical analyses. CM was responsible for data collection. All authors contributed to writing and revising of the manuscript.


The present study was supported by a research grant from the “Sunday’s Catering-Steniotis Bros Ltd” company. The study sponsor was not involved in data collection and interpretation.

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest to declare.


  1. 1.
    IDF Diabetes Atlas G (2015) Update of mortality attributable to diabetes for the IDF Diabetes Atlas: estimates for the year 2013. Diabetes Res Clin Pract. doi: 10.1016/j.diabres.2015.05.037 Google Scholar
  2. 2.
    WHO Study Group on Prevention of Diabetes Mellitus (1994) Prevention of Diabetes Mellitus. World Health Organization, GenevaGoogle Scholar
  3. 3.
    Lindstrom J, Neumann A, Sheppard KE et al (2010) Take action to prevent diabetes—the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 42(Suppl 1):S37–S55. doi: 10.1055/s-0029-1240975 CrossRefGoogle Scholar
  4. 4.
    Schwarz PE, Greaves CJ, Lindstrom J et al (2012) Nonpharmacological interventions for the prevention of type 2 diabetes mellitus. Nature reviews. Endocrinology 8:363–373. doi: 10.1038/nrendo.2011.232 Google Scholar
  5. 5.
    Eckel RH, Kahn R, Robertson RM et al (2006) Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Diabetes Care 29:1697–1699. doi: 10.2337/dc06-9911 CrossRefGoogle Scholar
  6. 6.
    Herman WH, Hoerger TJ, Brandle M et al (2005) The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med 142:323–332CrossRefGoogle Scholar
  7. 7.
    Knight KM, Dornan T, Bundy C (2006) The diabetes educator: trying hard, but must concentrate more on behaviour. Diabetic medicine: a journal of the British Diabetic Association 23:485–501. doi: 10.1111/j.1464-5491.2005.01802.x CrossRefGoogle Scholar
  8. 8.
    Vijan S, Stuart NS, Fitzgerald JT et al (2005) Barriers to following dietary recommendations in Type 2 diabetes. Diabetic medicine: a journal of the British Diabetic Association 22:32–38. doi: 10.1111/j.1464-5491.2004.01342.x CrossRefGoogle Scholar
  9. 9.
    Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine 346:393–403. doi: 10.1056/NEJMoa012512 CrossRefGoogle Scholar
  10. 10.
    Booth AO, Lowis C, Dean M et al (2013) Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals. Primary health care research & development 14:293–306. doi: 10.1017/S1463423612000412 CrossRefGoogle Scholar
  11. 11.
    Tapola N, Karvonen H, Niskanen L et al (2005) Glycemic responses of oat bran products in type 2 diabetic patients. Nutrition, metabolism, and cardiovascular diseases: NMCD 15:255–261. doi: 10.1016/j.numecd.2004.09.003 CrossRefGoogle Scholar
  12. 12.
    Kim H, Stote KS, Behall KM et al (2009) Glucose and insulin responses to whole grain breakfasts varying in soluble fiber, beta-glucan: a dose response study in obese women with increased risk for insulin resistance. Eur J Nutr 48:170–175. doi: 10.1007/s00394-009-0778-3 CrossRefGoogle Scholar
  13. 13.
    Kendall CW, Esfahani A, Josse AR et al (2011) The glycemic effect of nut-enriched meals in healthy and diabetic subjects. Nutrition, metabolism, and cardiovascular diseases: NMCD 21(Suppl 1):S34–S39. doi: 10.1016/j.numecd.2011.03.013 CrossRefGoogle Scholar
  14. 14.
    Kanellos PT, Kaliora AC, Liaskos C et al (2013) A study of glycemic response to Corinthian raisins in healthy subjects and in type 2 diabetes mellitus patients. Plant Foods Hum Nutr 68:145–148. doi: 10.1007/s11130-013-0348-y CrossRefGoogle Scholar
  15. 15.
    Panlasigui LN, Thompson LU (2006) Blood glucose lowering effects of brown rice in normal and diabetic subjects. Int J Food Sci Nutr 57:151–158. doi: 10.1080/09637480500410879 CrossRefGoogle Scholar
  16. 16.
    Fonda SJ, Jain A, Vigersky RA (2010) A head-to-head comparison of the postprandial effects of 3 meal replacement beverages among people with type 2 diabetes. The Diabetes educator 36:793–800. doi: 10.1177/0145721710378537 CrossRefGoogle Scholar
  17. 17.
    Schafer G, Schenk U, Ritzel U et al (2003) Comparison of the effects of dried peas with those of potatoes in mixed meals on postprandial glucose and insulin concentrations in patients with type 2 diabetes. The American journal of clinical nutrition 78:99–103Google Scholar
  18. 18.
    Wolever TM, Jenkins DJ, Jenkins AL et al (1991) The glycemic index: methodology and clinical implications. The American journal of clinical nutrition 54:846–854Google Scholar
  19. 19.
    Giacco R, Parillo M, Rivellese AA et al (2000) Long-term dietary treatment with increased amounts of fiber-rich low-glycemic index natural foods improves blood glucose control and reduces the number of hypoglycemic events in type 1 diabetic patients. Diabetes Care 23:1461–1466CrossRefGoogle Scholar
  20. 20.
    Nishimune T, Yakushiji T, Sumimoto T et al (1991) Glycemic response and fiber content of some foods. The American journal of clinical nutrition 54:414–419Google Scholar
  21. 21.
    Jenkins DJ, Jenkins AL (1985) Dietary fiber and the glycemic response. Proc Soc Exp Biol Med 180:422–431CrossRefGoogle Scholar
  22. 22.
    Augustin LS, Kendall CW, Jenkins DJ et al (2015) Glycemic index, glycemic load and glycemic response: an International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC). Nutrition, metabolism, and cardiovascular diseases: NMCD 25:795–815. doi: 10.1016/j.numecd.2015.05.005 CrossRefGoogle Scholar
  23. 23.
    Bornet FR, Costagliola D, Rizkalla SW et al (1987) Insulinemic and glycemic indexes of six starch-rich foods taken alone and in a mixed meal by type 2 diabetics. The American journal of clinical nutrition 45:588–595Google Scholar
  24. 24.
    Indar-Brown K, Noreberg C, Madar Z (1992) Glycemic and insulinemic responses after ingestion of ethnic foods by NIDDM and healthy subjects. The American journal of clinical nutrition 55:89–95Google Scholar
  25. 25.
    Nuttall FQ, Mooradian AD, Gannon MC et al (1984) Effect of protein ingestion on the glucose and insulin response to a standardized oral glucose load. Diabetes Care 7:465–470CrossRefGoogle Scholar
  26. 26.
    Ruige JB, Assendelft WJ, Dekker JM et al (1998) Insulin and risk of cardiovascular disease: a meta-analysis. Circulation 97:996–1001CrossRefGoogle Scholar
  27. 27.
    Ryden L, Grant PJ, Anker SD et al (2013) ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 34:3035–3087. doi: 10.1093/eurheartj/eht108 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yannis Manios
    • 1
    Email author
  • George Moschonis
    • 1
    • 2
  • Christina Mavrogianni
    • 1
  • Konstantina Tsoutsoulopoulou
    • 1
  • Stergios Kogkas
    • 1
  • Christina-Paulina Lambrinou
    • 1
  • Eirini Efstathopoulou
    • 1
  1. 1.Department of Nutrition and DieteticsHarokopio University of AthensKallithea, AthensGreece
  2. 2.Envinhealth S.A.Marousi, AthensGreece

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