Associations of Dietary Glucose, Fructose, and Sucrose with Beta-cell Function, Insulin Sensitivity and T2DM Study Summary

For your information, a study entitled “Associations of Dietary Glucose, Fructose, and Sucrose with β–cell Function, Insulin Sensitivity, and Type 2 Diabetes in the Maastricht Study” by den Biggelaar et al. was recently published in Nutrients. The purpose of the study was to determine associations between glucose, fructose, and sucrose intakes with β–cell Function (BCF), insulin sensitivity, prediabetes and newly diagnosed type 2 diabetes (T2DM).

den Biggelaar et al. extrapolated data from 2818 participants aged 40-75 years living in the southern part of The Netherlands participating in the Maastricht Study, an observational prospective population based cohort study..

Glucose metabolism status was determined by an oral glucose tolerance test. Plasma insulin and C-peptide were also measured. Glucose metabolism was defined as normal glucose metabolism (NGM), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or T2DM. BCF was determined by β–cell glucose sensitivity, the potentiation factor ratio, β–cell rate sensitivity, C-peptidogenic index and the ration of the C-peptide to glucose area under the curve. The Matsuda index was used to measure insulin sensitivity. Dietary intake was assessed using the Dutch national Food Frequency Questionnaire (FFQ) tool. Total energy intake and intakes glucose, fructose, and sucrose were calculated using the Dutch Food Composition Database. Intakes were organized into quintiles for analysis. Body weight, height, BMI, waist and hip circumference, blood pressure, blood lipid profiles, smoking status, physical activity levels, medication use, history of cardiovascular disease (CVD), and history of cancer were all recorded and considered for statistical analysis. Model 1 adjusted for sex and age only. Model 2 adjusted for model 1 plus waist-to-hip ratio, education level, mean arterial blood pressure, CVD, anti-hypertensive medication, lipid-modifying medication, family history of T2DM, moderate-to-vigorous physical activity, and intake of total energy, dietary fiber, and alcohol.

den Biggelaar et al. report the following results:

  • Of the 2818 participants included in the study, 1757 had NGM, 456 had pre diabetes, 120 were newly diagnoses with T2DM, and 485 were previously diagnosed with T2DM.

o   Note: analyses for BCF or insulin sensitivity as outcome measure were repeated after exclusion of individuals with previously diagnosed T2DM, due to possibility that they may have modified their diet

  • Prevalence of overweight, obesity, high waist-to-hip ratio, hypertension, and history of CVD was lowest among those with NGM and highest among those with T2DM.
  • BCF and insulin sensitivity were highest among NGM individuals and lowest among T2DM individuals.
  • Glucose, fructose, and sucrose intakes were highest in the NGM group.
  • No significant differences in total energy intake were observed between all groups.
  • Compared to individuals with the highest glucose and fructose intakes, individuals with the lowest glucose and fructose intakes were younger, more often male, were often current smokers, had higher prevalence of overweight/obesity, had higher prevalence of prediabetes/T2DM, were less physically active, and consumed less fruits and vegetables.
  • Compared to individuals with the highest sucrose intake, individuals with the lowest sucrose intake were older, more often normal weight, were often male, were often current smokers, had higher prevalence of T2DM, and consumed less fruits and vegetables.
  • Glucose intakes in the 3rd, 4th, and 5th quintiles were associated with higher β–cell glucose sensitivity, total insulin secretion, and insulin sensitivity but not with BCF.
  • Fructose intake was not associated with BCF or insulin sensitivity.
  • Sucrose intake in the 4th quintile was associated with β–cell glucose sensitivity but was not associated with other BCF indices and insulin sensitivity.
  • Glucose intake in the 4th and 5th quintiles were associated with a lower odds of prediabetes. Fructose and sucrose intake were not associated with prediabetes odds.
  • Higher intakes of glucose (4th and 5th quintiles) were associated with lower odds of IGT.
  • A gram increment of glucose intake was associated with lower odds of both IFG and IGT. Fructose and sucrose were not associated with IFG and IGT odds.

den Biggelaar et al. conclude that “In the fully adjusted models, a positive association of glucose, but not of fructose and sucrose intake, was found with insulin sensitivity…High glucose intake was associated with higher insulin sensitivity and a decreased odds of prediabetes, independent of dietary fibre. There is no convincing evidence for associations of glucose, fructose, and sucrose intake with BCF.”