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Carbohydrates are among the macronutrients that have the greatest impact on blood sugar response. Cooling rice after cooking will cause the starch to regenerate and become indigestible in the human digestive tract.
The purpose of this study was to evaluate whether rice refrigeration affects postprandial blood glucose levels in patients with type 1 diabetes.
The study included 32 patients with type 1 diabetes mellitus. Each study participant ate two standardized test meals consisting of long-grain white rice. One test meal was consumed immediately after preparation, and the other test meal was cooled to 4°C within 24 hours of preparation and reheated before consumption. Each patient had their blood glucose measured 3 hours postprandially using the FreeStyle Libre rapid glucose monitoring system.
Compared with fresh rice, the maximum blood glucose value was significantly reduced (11 vs. 9.9 mmol/L, p = 0.0056), and the maximum blood glucose value increased (2.7 vs. 3.9 mmol/L) after eating chilled dough rice dish. L, p < 0.0001), area under the blood glucose curve (135 vs. 336 mmol/L * 180 minutes, p < 0.0001), and significantly shorter time to peak (35 vs. 45 minutes, p = 0.031). During the 180-minute observation period, patients consuming the cold rice test meal experienced significantly more episodes of hypoglycemia compared with fresh rice (12 (38) vs 3 (9), p = 0.0039).
Consumption of refrigerated rice reduces postprandial rise in blood sugar in patients with type 1 diabetes. Also, the use of standard doses of insulin increases the risk of postprandial hypoglycemia.
Diabetes is a group of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both. Almost 10% of diabetic patients suffer from type 1 diabetes [1, 2]. The recommended treatment for type 1 diabetes is intensive insulin therapy. The main goal of diabetes treatment is to achieve blood glucose levels (both postprandial and fasting) similar to those of healthy people to reduce the risk of chronic diabetes complications. The most effective way to achieve this goal is continuous subcutaneous infusion of insulin using an insulin pump [3].
Carbohydrates are among the macronutrients that have the greatest influence on the glycemic response [4]. Rice is one of the most common sources of carbohydrates consumed by diabetics. Rice is also a staple food for more than half of the world’s population [5, 6]. The main carbohydrate in rice is starch. This polysaccharide exists in semi-crystalline form in granules and consists of two polymers: amylose and amylopectin [7]. Starch products are often heat treated before consumption to improve their use and digestibility. In a process commonly known as gelatinization, starch granules are broken down by heating in water, making the molecules fully accessible to digestive enzymes [8]. When cooked starchy foods are refrigerated, resistant starch is formed, reducing the amount of carbohydrates available. This type of starch is formed through a process called retrogradation. When starch is cooled, amylose molecules and long branches of amylopectin form a double helix and lose their water-binding ability. The double helix of the starch molecule is resistant to hydrolysis by amylase. Crystalline forms of starch resist enzymatic degradation in the small intestine, thereby reducing the concentration of digestible starch in cooked starchy foods [9, 10]. The above phenomenon may benefit diabetic patients as converting starch into an unavailable form may help reduce postprandial blood glucose values and reduce blood glucose variability. There are currently no scientific reports on the effect of retrograde starch on postprandial blood glucose levels in patients with type 1 diabetes. Research is needed to evaluate this relationship. Studies have been conducted to prove that the above phenomenon can provide measurable benefits for the metabolic control of diabetes.
The purpose of this study was to evaluate whether rice refrigeration affects postprandial blood glucose levels in patients with type 1 diabetes. Other objectives include assessing the effect of rice refrigeration on hypoglycemic episodes, as well as levels of hunger, satiety, and desire to eat. In addition, sensory evaluation of the chilled rice was carried out.
Thirty-two patients with type 1 diabetes were recruited from the Department of Internal Medicine and Diabetes, Medical University of Poznan, Poland. Inclusion criteria included: 1/type 1 diabetes mellitus, age over 18 years, 2/intensive insulin therapy using a personal insulin pump, 3/body mass index less than 30 kg/m2, 4/HbA1c <9%, 5/written consent to participate in the study. Exclusion criteria included: 1/Pregnancy, 2/Other types of diabetes, 3/Eating disorders, 4/Food allergies or intolerance to standardized food ingredients, 5/History of celiac disease, 6/Autonomic neuropathy, including gastroparesis, 7/Personal product use hygiene. insulin pump therapy for <3 months.
Body composition analysis using bioelectrical impedance camera BODY COMPOSITION ANALYZER BC-418 MA’s TANITA. In particular, check the fat content and free fat mass.
In addition, each patient underwent the following laboratory tests: 1/Glycated hemoglobin (HbA1c in whole blood), 2/High-density lipoprotein (HDL), 3/Low-density lipoprotein (LDL), 4/Total cholesterol (TC). ), 5/triglyceride.
HbA1c was determined by turbidimetric inhibition immunoassay using a Cobas 6000 analyzer (Roche Diagnostics, Basel, Switzerland). Other measurements were performed using enzyme assays on a Cobas 6000 analyzer.
All participants received intensive insulin therapy using a personal insulin pump with a bolus calculator.
Before the start of the study, to minimize the impact of the basal rate on blood glucose levels during testing, each patient tested their basal rate between 1:00 p.m. and 5:00 p.m. If the basal rate is not optimal during this period, resulting in fluctuations in blood glucose levels, appropriate changes should be made under the supervision of a physician. Basal rates did not change on days when food intake was monitored.
The Bioethics Committee of the Poznań Medical University, Poland, approved this clinical study (ethical approval number: 198/18 of 01.02.2018). The study was designed as a randomized, single-blind, crossover study.
Each study participant ate two standardized test meals consisting of long-grain white rice. One test meal was freshly prepared and served immediately after preparation. Another test meal was cooled to 4°C within 24 hours of preparation and then reheated before serving to the patient.
The test meal will be provided on the day of the test only if the patient has not experienced hypoglycemia in the 24 hours prior to the test. Before consuming the test meal, participants were required to have a target blood glucose level of 3.9–10 mmol/L. Test meals were always served at the same time, 2 p.m. Meal time is set to 10 minutes. The interval between the last meal and the standardized test meal was 5 hours. During this period, subjects were allowed to drink only water. Participants were also asked to avoid unusually strenuous physical activity starting the day before each test. Study participants were asked not to exercise before the study until the test meal was completed.
Patients always consumed the study test food in the same room and in a similar environment. The patient did not know whether it was freshly cooked rice or pre-chilled rice. To ensure blinding, pre-chilled test dishes were heated to the same temperature as fresh dishes.
Ten minutes before the test meal, patients received a bolus of insulin (Lispro/Aspart) based on the carbohydrate metabolism ratio, correction factor, and insulin sensitivity factor. Your insulin dosage is calculated based on the bolus calculator programmed into your pump. Before administering the test meal, there should be no remaining active insulin from the previous bolus. All subjects had stable blood glucose levels before insulin injections and meals, which was confirmed by the FreeStyle Libre rapid blood glucose monitoring system.
Long grain white rice was used in the study. Procedures for preparing and serving the test meal were standardized. Test dishes were prepared by boiling water using a Silver Crest induction hob model SIKP 2000 E2.
Test dishes were prepared using 70 g of dry product and 280 ml of water. Place rice in boiling water and cook for 18 minutes.
The test meal consisted of 200 grams of rice (containing 46 grams of carbohydrates) and 100 grams of tomato paste (containing 4 grams of carbohydrates).
Tomato sauce contains no seasonings. The entire meal contains a total of 50 grams of carbohydrates.
When ready, pre-weigh a portion of rice and refrigerate at 4°C for 24 hours. Once cooled, reheat by immersing one portion of rice (200g) in 250ml hot water for 3 minutes.
Rice samples were analyzed for total energy, carbohydrate, protein, fat, ash, total starch, fiber and water content. Check the resistant starch content of freshly cooked and cooled rice. Protein content was analyzed using the Dumal method [11]. Fat content was studied by NMR [12]. Starch content was analyzed using optical polarimetry [13]. Ash content was checked by the direct/dry method [14]. The carbohydrate content was determined by the difference using the following formula: % total carbohydrates = [100-% (protein + fat + moisture + ash + fiber)] [15]. Fiber content was analyzed by enzymatic methods [16]. The water content was determined with a thermometer [17]. Fresh and chilled test rice (after reheating) was analyzed for resistant starch content using the AOAC 2002.02 method [18]. All analyzes except carbohydrate content were performed in duplicate. The arithmetic mean of two values obtained as a result of the analysis was used as the result.
Assess your post-meal blood glucose levels after 3 hours with the FreeStyle Libre Rapid Blood Glucose Monitoring System. Measurements are taken every 5 minutes. Take FreeStyle Libre at least 2 days before your first food test.
Patients were asked to eat the same type of breakfast on all testing days to minimize the effect of the first meal on blood glucose levels. Subsequently, breakfast consumption data prior to the test meal were collected and analyzed for total energy, carbohydrates, protein, fat, and dietary fiber. We used the Dietitian 2014 program and added a database of Polish food products.
If hypoglycemia occurs during the study, the study is stopped and the patient is asked to eat 15-20 grams of rapidly absorbed sugar. Blood glucose measurements were then repeated over the next 15 minutes according to the recommendations of the Polish Diabetes Association. FreeStyle Libre blood glucose readings below 3.9 mmol/L or symptomatic episodes of hypoglycemia were verified by measuring capillary blood glucose using an OptiumXido Abbott Diabetes Care meter. The time of the incident was recorded.
During the study, each participant completed a sensory assessment questionnaire that assessed the taste, visual appeal, smell and texture of the food being tested.
Levels of hunger, satiety and desire to eat were assessed using a proprietary questionnaire based on visual analogue scales. Study participants rated the perceived intensity of each feature on a scale from 0 to 10. Questionnaires were completed before and 30, 60, 120 and 180 minutes after eating the test food.
Statistica PL version 13 (StatSoft, Inc., Tulsa, OK, USA) and MedCalc statistical software version 19.3.1 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2020). Graphical presentation of analytical data results. Results are presented as medians (IQR, interquartile range) for continuous variables or as numbers and percentages for nominal variables. Continuous variables were tested for normality using the Shapiro-Wilk test. Normally distributed variables were compared using the paired t test, and for continuous variables that did not meet its assumptions, the Wilcoxon signed-rank test was used.
The mean duration of insulin pump therapy was 6.0 ± 3.7 years. The mean HbA1c was 6.9 ± 0.6%. Lipid parameters in all participants were within normal limits (Table 1). The patient does not smoke, has no allergies or food intolerances. No chronic complications of diabetes were observed in the main group.
Analysis shows that long grain white rice contains 435.34 kJ (104 kcal), 2.47 g protein, 0.1 g fat, 23 g carbohydrates, 21.7 g starch, 0.95 g fiber, 74.4 g water and 0.1 g. Ash content per 100 g. The resistant starch content of fresh and chilled tested rice was 7.52 ± 0.05 and 11.96 ± 0.04 g/100 g, respectively.
Compared with fresh rice, maximum blood glucose values were significantly lower [9.9 (9.4–10.9) vs. 11 (10.3–11.7) mmol/L, p = 0.0056] and increased [ 2.7] (1.5–3.6) versus 3.9. (2.5–4.7) mmol/l, p < 0.0001], increase in the area under the blood glucose curve [135 (34.3–283.9) versus 336 (123.9–486.9) mmol /l * 180 minutes, p < 0.0001] and the time of peak blood glucose was significantly reduced [35(28–43) vs. 45(35–55) minutes, p = 0.031] (Table 2). Figure 1 shows the increase in blood glucose levels after eating a meal containing fresh or cold rice.
There was no significant difference in insulin doses tested between fresh rice and cold rice [5.4 (4.9–6.0) vs. 5.5 (5.0–6.1) units, p = 0.92]. Basal insulin doses on test meal days were not significantly different between fresh rice and cold rice [15.8 (13.0–19.9) vs. 15.8 (13.0–19.9) units (p = 0.66 ).
Breakfast was the last meal consumed by all patients before the test meal, and there were no differences in energy, protein, fat, carbohydrate, or fiber content between study groups. In addition, there was no difference in the dose of insulin administered before breakfast between the two groups (Table 3).
Breakfast was the last meal before the test meal for all patients, and there were no differences in energy, protein, fat, carbohydrate, or fiber content between study groups. In addition, there were no differences in pre-breakfast insulin doses between the two groups.
During the 180-minute observation period, subjects who consumed the cold rice test meal experienced significantly more hypoglycemic episodes than subjects who consumed fresh rice (12 vs. 3, p = 0.0039) (Table 4).
In the organoleptic evaluation of test dishes made from fresh and cold rice, no significant differences were found in taste [7(6-8) vs. 7(6-8) points, p = 0.97), external attractiveness of dishes [7(5) - 8) versus 7(5-8) points, p = 0.72], smell [7(6-9) versus 7(6-8) points, p = 0.32] and consistency [6(5-7) vs. 6(4–7) points, p = 0.53]. Study subjects thought the food tasted the same.
The study observed no significant differences between fresh and cold rice test meals in terms of hunger, fullness and desire to eat 30, 60, 120 and 180 minutes after eating.
The initial results of this study demonstrate for the first time that the use of a specific thermal treatment method (cooling precooked starch products) has a beneficial effect on postprandial blood glucose concentrations in patients with type 1 diabetes. This is due to the phenomenon of formation of resistant starch during the cooling of starch products [19, 20]. Yadav et al. Research has shown that repeated heating/cooling cycles of starch products further increases the resistant starch content [21]. In this study, test dishes were refrigerated for 24 hours. Only one cooling and warming cycle was performed to ensure the safety and microbial purity of the test dishes analyzed and to enhance the suitability of the procedure for future practical application in patients.
To date, the effect of consumption of refrigerated starchy foods on postprandial blood glucose levels in patients with diabetes mellitus is unknown. A similar procedure was used in the current study by Sonia et al. But it was carried out on healthy people [22]. This study analyzed the glycemic response of freshly cooked white rice (control rice) and cooked white rice that was cooled to 4°C for 24 hours and then reheated. The study reported that the area under the blood glucose curve after consuming refrigerated rice (125 ± 50 mmol/L*min) was lower than that of fresh rice (152 ± 48.3 mmol/L*min). Similar results were obtained by Ananda et al. [twenty three]. However, some authors have not confirmed the effect of cooling starchy foods on postprandial blood glucose [24, 25].
Our results are particularly valuable because they were confirmed in a specific group of patients with type 1 diabetes mellitus who lack endogenous insulin secretion.
In our study, test meals containing frozen rice took less time to peak blood sugar levels than fresh rice.
This may help improve glycemic control as the delayed glycemic peak better covers the peak activity of short-acting insulin analogues [26].
Current scientific reports show that postprandial blood glucose levels depend not only on the nutritional value of the last meal, but also on previously consumed foods. In a study by Meng et al. A smaller area under the postprandial glucose test curve was observed when a high-protein breakfast was eaten first compared to a carbohydrate- and fat-rich breakfast [27]. A study by Grunfeldt et al. The glycemic response is lower if the previous meal is rich in fiber [28].
In our study, the energy value, protein, fat, carbohydrate and fiber content of the tested breakfasts were the same. This minimizes the influence of the previous meal on post-meal blood sugar measurements.
The formation of type 3 resistant starch during cooling of cooked starch products reduces the content of accessible and easily digestible carbohydrates in the diet [19]. The higher number of hypoglycemic episodes in our study could be due to the use of the same dose of insulin during both test meals. To reduce the risk of hypoglycemia in patients with insulin-dependent diabetes, consider reducing the insulin dose at each meal of refrigerated rice. It can be assumed that in 100 g of chilled rice the content of easily digestible carbohydrates is reduced by approximately 5 g compared to a freshly prepared product.
Lin et al. studied the effect of eating a meal rich in resistant starch in patients with type 2 diabetes and found that postprandial blood glucose levels were reduced but the risk of hypoglycemia was not increased [29]. However, it should be noted that the majority of participants in this study were receiving oral medications, whereas a small proportion of patients were using prandial insulin.
Post time: Aug-14-2024