EBSCO AND SCOPUS

Effects of cooked rice containing

high resistant starch on postprandial
plasma glucose, insulin, and incretin in
patients with type 2 diabetes.

Background and Objectives: Few studies exist on resistant starch in rice grains. The Okinawa Institute
of Science and Technology Graduate University (OIST) has developed a new rice (OIST rice, OR)
rich in resistant starch. This study aimed to clarify the effect of OR on postprandial glucose
concentrations. Methods and Study Design: This single-center, open, randomized, crossover
comparative study included 17 patients with type 2 diabetes. All participants completed two meal
tolerance tests using OR and white rice (WR). Results: The median age of the participants was 70.0
[59.0-73.0] years, and the mean body mass index was 25.9±3.1 kg/m^2. The difference in total area
under the curve (AUC) of plasma glucose was -8223 (95% confidence interval [CI]: -10100 to -6346,
p<0.001) mg．min/dL. The postprandial plasma glucose was significantly lower with OR than with
WR. The difference in the AUC of insulin was -1139 (95% CI: -1839 to -438, p=0.004) µU．min/mL.
The difference in the AUC of total gastric inhibitory peptide (GIP) and total glucagon-like peptide-1
(GLP-1) was -4886 (95% CI: -8456 to -1317, p=0.011) and -171 (95% CI: -1034 to 691, p=0.673)
pmol．min/L, respectively. Conclusions: OR can be ingested as rice grains and significantly reduced
postprandial plasma glucose compared to WR independent of insulin secretion in patients with type 2
diabetes. OR could have escaped absorption not only from the upper small intestine but also from the
lower small intestine.
Effects of resistant starch on glycemic
response, postprandial lipemia and appetite
in subjects with type 2 diabetes.
Purpose
Resistant starch (RS) content has exhibited beneficial effects on glycemic control; however, few
studies have investigated the effects of this substance on postprandial responses and appetite in
subjects with type 2 diabetes (T2D). Here, we aimed to examine the effects of RS from two sources
on glycemic response (GR), postprandial lipemia, and appetite in subjects with T2D.
Methods
In a randomized and crossover study, 17 subjects with T2D consumed native banana starch (NBS),
high-amylose maize starch (HMS) or digestible maize starch (DMS) for 4 days. On day 5, a 6-h oral
meal tolerance test (MTT) was performed to evaluate glycemic and insulinemic responses as well as
postprandial lipemia. Besides, subjective appetite assessment was measured using a visual analogue
scale.
Results
NBS induced a reduction on fasting glycemia, glycemia peak and insulinemic response during MTT.
However, no modifications on postprandial lipemia were observed after RS treatments. Both NBS and
HMS reduced hunger and increased satiety.
Conclusion
NBS supplementation induced more beneficial effects on glycemic metabolism than HMS even when
all interventions were matched for digestible starch content. RS intake did not modify postprandial
lipemia, however, positively affected subjective appetite rates.
Does a high dietary intake
of resistant starch affect glycaemic control
and alter the gut microbiome in women with
gestational diabetes? A randomised control
trial protocol.
Abstract
Background: Gestational Diabetes Mellitus (GDM) is prevalent with lasting health
implications for the mother and offspring. Medical nutrition therapy is the foundation
of GDM management yet achieving optimal glycaemic control often requires
treatment with medications, like insulin. New dietary strategies to improve GDM
management and outcomes are required. Gut dysbiosis is a feature of GDM
pregnancies, therefore, dietary manipulation of the gut microbiota may offer a new
avenue for management. Resistant starch is a fermentable dietary fibre known to
alter the gut microbiota and enhance production of short-chain fatty acids. Evidence
suggests that short-chain fatty acids improve glycaemia via multiple mechanisms,
however, this has not been evaluated in GDM. Methods: An open-label, parallel-
group design study will investigate whether a high dietary resistant starch intake or
resistant starch supplement improves glycaemic control and changes the gut
microbiome compared with standard dietary advice in women with newly diagnosed
GDM. Ninety women will be randomised to one of three groups - standard dietary
treatment for GDM (Control), a high resistant starch diet or a high resistant starch
diet plus a 16 g resistant starch supplement. Measurements taken at Baseline (24 to
30-weeks’ gestation), Day 10 and Day 56 (approximately 36 weeks’ gestation) will
include fasting plasma glucose levels, microbial composition and short-chain fatty
acid concentrations in stool, 3-day dietary intake records and bowel symptoms
questionnaires. One-week post-natal data collection will include microbial
composition and short-chain fatty acid concentrations of maternal and neonatal
stools, microbial composition of breastmilk, birthweight, maternal and neonatal
outcomes. Mixed model analysis of variance will assess change in glycaemia and
permutation-based multivariate analysis of variance will assess changes in microbial
composition within and between intervention groups. Distance-based linear
modelling will identify correlation between change in stool microbiota, short-chain
fatty acids and measures of glycaemia. Discussion: To improve outcomes for GDM
dyads, evaluation of a high dietary intake of resistant starch to improve glycaemia
through the gut microbiome needs to be established. This will expand the dietary
interventions available to manage GDM without medication. Trial registration:
Australian New Zealand Clinical Trial Registry, ACTRN12620000968976p.
Registered 28 September 2020. © 2022, The Author(s).
Author keywords
Diet therapy; Fasting glucose; Gestational diabetes; Gut microbiome; Resistant
starch; Short-chain fatty acids
Resistant StarchConsumption Effects on
Glycemic Control and Glycemic Variability in
Patients with Type 2 Diabetes: A Randomized
Crossover Study.
Abstract
We previously observed beneficial effects of native banana starch (NBS) with a high
resistant starch (RS) content on glycemic response in lean and obese participants.
Here, we aimed to determine the effects of NBS and high-amylose maize starch
(HMS) on glycemic control (GC) and glycemic variability (GV) in patients with type 2
diabetes (T2D) when treatments were matched for digestible starch content. In a
randomized, crossover study, continuous glucose monitoring (CGM) was performed
in 17 participants (aged 28–65 years, BMI ≥ 25 kg/m2, both genders) consuming
HMS, NBS, or digestible maize starch (DMS) for 4 days. HMS and NBS induced an
increase in 24 h mean blood glucose during days 2 to 4 (p < 0.05). CONGA,
GRADE, and J-index values were higher in HMS compared with DMS only at day 4
(p < 0.05). Yet, NBS intake provoked a reduction in fasting glycemia changes from
baseline compared with DMS (p = 0.0074). In conclusion, under the experimental
conditions, RS from two sources did not improve GC or GV. Future longer studies
are needed to determine whether these findings were affected by a different baseline
microbiota or other environmental factors. © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.
Author keywords
Banana; Continuous glucose monitoring; Glycemic control; Glycemic variability; Resistant
starch; Type 2 diabetes
Naturally cultured high resistant starch rice improved postprandial glucose levels in patients
with type 2 diabetes: A randomized, double-blinded, controlled trial

Abstract
Objective: To assess the effect of a novel naturally cultured rice with high resistant starch (RS) on
postprandial glycemia in patients with type 2 diabetes compared to ordinary rice. Design: This study
is a randomized, double-blinded controlled trial. Methods: Patients with type 2 diabetes were
recruited, and postprandial glucose levels were measured at 5-time points after the ingestion of one of
two types of cooked rice in random order. Paired t-tests were used to compare postprandial blood
glucose changes and increment areas under the blood glucose curve between high-RS rice and
ordinary rice. Results: The increments of the postprandial blood glucose levels for high-RS rice were
significantly lower than that for ordinary rice, i.e., 2.80 ± 1.38 mmol/L vs. 3.04 ± 1.50 mmol/L (P =
0.043) and 3.94 ± 2.25 mmol/L vs. 4.25 ± 2.29 mmol/L (P = 0.036) at 30 min and 60 min,
respectively. The incremental areas under the blood glucose curve for high-RS rice were also
significantly lower than that for ordinary rice, i.e., 42.04 ± 20.65 [mmol/(L·min)] vs. 45.53 ± 22.45
[mmol/(L·min)] (P = 0.043), 143.54 ±69.63 [mmol/(L·min)] vs. 155.15 ± 73.53 [mmol/(L·min)] (P =
0.026), and 354.61 ± 191.96 [mmol/(L·min)] vs. 379.78 ± 195.30 [mmol/(L·min)] (P = 0.042) at 30,
60, and 120 min, respectively. Repeated-measures ANOVA showed that postprandial glucose levels
were not affected by the test order. Conclusion: The novel high-RS rice as a staple food when
substituting for widely consumed ordinary rice may provide potential health benefits by lowering
blood glucose in patients with type 2 diabetes. Copyright © 2022 Tan, Duan, Chen, Mei, Qi and
Zhang.
Author keywords
diabetes; postprandial glucose level; randomized controlled trial (RCT); resistant starch (RS); rice
Influence of resistant starch resulting from the cooling of rice on postprandial glycemia in type 1
diabetes

INTRODUCTION: Carbohydrates are one of the macronutrients which have the most substantial
influence on glycemic response. The cooling of rice after cooking causes retrogradation of starch,
which becomes a non-absorbable product in the human digestive tract. AIM OF THE STUDY: This
study aimed to assess whether cooling of rice affects postprandial glycemia in subjects with type 1
diabetes. MATERIALS AND METHODS: The study included 32 patients with type 1 diabetes. Each
participant of the study consumed two standardized test meals consisting of long-grain white rice. One
of the test meals was served immediately after preparation, and another was cooled for 24 h at 4 °C
after preparation and reheated before being served. Postprandial glycemia was measured for 3 h using
the FreeStyle Libre flash glucose monitoring system for each patient. RESULTS: After consumption
of the test meal containing rice subjected to the cooling process when compared to fresh rice, a
significantly lower value of maximum glycemia (11 vs. 9.9 mmol/L, p = 0.0056), maximum glycemic
increase (2.7 vs. 3.9 mmol/L, p < 0.0001), areas under the glycemic curve (135 vs. 336 mmol/L * 180
min, p < 0.0001) and significantly shorter time to peak (35 vs. 45 min, p = 0.031) was observed. There
was a significantly higher number of hypoglycemic episodes among the patients after consuming test
meals with cooled rice compared to fresh ones during 180 min of observation (12(38) vs. 3(9), p =
0.0039). CONCLUSIONS: Consumption of rice subjected to the cooling process results in a lower
increase of postprandial blood glucose in subjects with type 1 diabetes. At the same time it increases
the risk of postprandial hypoglycemia using a standard insulin dose.