The Impact of a Fat-Dominant Preload Before a Carbohydrate-Rich Meal on Glucose Homeostasis in Patients Without Diabetes After Sleeve Gastrectomy: A Proof-of-Concept, Randomised, Open-Label, Crossover Study
Abstract
Background/objectives: Sleeve gastrectomy (SG) improves glycaemic control; however, it also markedly accelerates gastric emptying, which can lead to exaggerated postprandial glucose and insulin excursions and, in some cases, postprandial hyperinsulinaemic hypoglycaemia. In non-surgical populations, fat preloads can reduce postprandial glycaemia by slowing gastric emptying, but their effects after SG are unclear.
Methods: Ten adults >1-year post-SG completed a randomised, open-label, crossover study involving two mixed-meal tolerance tests (MMTTs), preceded (-30 min) by either a moderate, fat-dominant preload (28 g Brazil nuts) or 100 mL water (control). Blood samples were collected over three hours to assess plasma glucose, insulin, c-peptide, and total glucagon-like peptide-1 (GLP-1). Hypoglycaemia and dumping symptoms were assessed using validated questionnaires. Nadir plasma glucose concentration was the primary outcome.
Results: Nadir plasma glucose was identical between conditions (both 3.8 mmol/L; 95% CI: -0.4, 0.3, p = 0.849), and neither peak glucose nor overall postprandial glucose exposure (incremental area under the curve iAUC0-180 min) differed between the preload and water conditions. Insulin and c-peptide concentrations immediately before the MMTT were higher after the fat-dominant preload (both p 0-180 min) remained comparable between conditions (95% CI -225, 2665; p = 0.442 and -67,787, 70,263; 0.968), but peak values for both hormones were higher after the…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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