Carbohydrate tolerance and food frequency.

Dietary and pharmacological approaches to slowing the rate of glucose absorption and blunting the insulin response show promise in the treatment of diabetes and hyperlipidaemia. These approaches include dietary fibre, low-glycaemic-index foods and gastrointestinal digestive enzyme inhibitors. One common feature is that they spread the nutrient load over time. A potentially simpler approach is to take more frequent smaller meals over a longer period of the day. Early studies suggested that frequent glucose and insulin administration to diabetic patients improved diabetes control. More recent acute studies of one test meal or 1 d blood metabolite profiles have identified a significant economy in insulin secretion when glucose is sipped or when meal frequency is increased in both diabetic or non-diabetic subjects. In diabetic subjects improvement in mean blood glucose levels has also been reported. However, despite the demonstration of an alteration in response over time in glucose tolerance in healthy volunteers, no longer-term improvement in glycaemic control was reported in the only study in diabetes to examine a change from three to nine meals daily over a 1-month period. The disparity between longer-term and acute studies requires further investigation. At present, although this nutritional approach holds considerable theoretical promise, specific advice is premature.