3. Discussion
hyperglycaemia, diabetes
HYPERGLYCAEMIA, TYPE 2 DIABETES, COMPLICATIONS, DIABETES
In this acute, randomized, crossover study, we investigated if the extract obtained from the brown seaweed A significant variation in the glycaemic response to the control starch-rich meal (white bread) between subjects was observed in the trial. Compared to the control group, significant effects of interventions on either glucose or insulin levels were not observed in the total group of 16 subjects included in the trial. However, a shift in the time of the detected peak glucose values (tmax), from 30 min after the control meal to 45 min was observed after both intervention meals (with either a low or high dose of the extract). Clustering the subjects into two sub-cohorts based on their peak glucose response to the control meal allowed the comparison of responders with significantly different responses from baseline to the carbohydrate load in terms of iCmax, Cmax, or iAUC for glucose. In the sub-cohort of “higher-normal” responders, the brown seaweed extract significantly decreased the maximum incremental concentration of glucose after the starch-rich meal by 22% (Postprandial hyperglycaemia is a well-established, independent cardiovascular risk factor in patients with diabetes [In a recent study, Hall et al. used continuous glucose monitoring to evaluate the frequency of elevations in postprandial glucose over 2–4 weeks. They identified three “glucotypes”, i.e., glucose fluctuation patterns: low variability, moderate variability, and severe variability [The mechanisms that underlie the effects of brown seaweeds and their bioactives on carbohydrate metabolism and glucose homeostasis include: (a) inhibition of enzymes of carbohydrate digestion, salivary and pancreatic α-amylases and α-glucosidases (e.g., maltase glucoamylase and sucrase-isomaltase) [The extract tested in this trial was obtained through the process of biological activity-guided optimization based on the inhibition of enzymes of carbohydrate digestion, salivary α-amylase and α-glucosidases, as the main targets for its action. The main bioactives identified in the extract were polyphenols and sulfated polysaccharides [The number of previous studies that tested the impact of brown seaweed extract on glycaemic control after a meal is limited. Paradis et al. [In another set of studies, the role of postprandial glycaemic response was examined by testing the effects of In a study on the acute effects of While no effect was seen on the total population, the current study identified a cohort of patients who were responsive to the treatments. In nutrition research, individuals’ responses to dietary interventions are known to be highly variable [One of the factors that was previously reported to influence the postprandial glycaemic response to starchy foods is the activity of salivary α-amylase [Similar to our study, Wascher et al. [Synthetic alpha-glucosidase inhibitors (acarbose, voglibose, and miglitol) are therapeutics used for the treatment or prevention of type 2 diabetes and its complications [There are some limitations to this study. Our primary outcome was iCmax; however, the participants were not recruited based on iCmax or any other parameter of glycaemic control. Secondly, the number of participants was calculated based on the results of a pilot study that reported a 50% higher iCmax value in response to a control meal. In addition, the study was not controlled for various factors reported to affect postprandial glycaemic response that might have contributed to the observed inter-individual variability. Nevertheless, we made efforts to minimize intra-individual variability by implementing controls at the individual level for certain factors such as diet, physical activity, and stress.