Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes

European Journal of Clinical Nutrition · 7 authors, 5 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAsian Indian adults (n=60, 27 male, 33 female, mean age 41.3 years) with prediabetes (fasting glucose 5.6–7 mmol/L and/or 2-hour plasma glucose 7.8–11.1 mmol/L after 75 g oral glucose)

INTERVENTIONPremeal almond load: 20 g almonds consumed 30 minutes before a 75 g oral glucose load (OGTT phase) or 20 g almonds 30 minutes before each major meal (breakfast, lunch, dinner) for 3 days (CGMS phase)

COMPARISONControl diet: no food/almonds before OGTT (OGTT phase) or standard diet without premeal almonds (CGMS phase)

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TL;DR

This randomized crossover trial in 60 Asian Indians with prediabetes found that consuming 20 g of almonds 30 minutes before each major meal significantly reduced postprandial hyperglycemia and improved glucose variability. On oral glucose tolerance testing, the premeal almond load reduced postprandial blood glucose area under the curve by 18.05%, with 24.8% and 28.9% reductions at 1-hour and 2-hour time points, respectively. Continuous glucose monitoring over 3 days confirmed improved glycemic control, including lower mean 24-hour glucose, reduced time above 7.8 mmol/L, and improved glycemic variability measures, suggesting a simple dietary strategy to mitigate diabetes progression in a high-risk population.

Full summary

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**Background:** Asian Indians have a high rate of conversion from prediabetes to type 2 diabetes (T2D) and exhibit pronounced postprandial hyperglycemia (PPHG), which increases cardiovascular risk. Dietary strategies targeting PPHG are needed. Previous research by the authors showed that pistachios improved cardiometabolic factors and almonds as a snack improved HbA1c, but effects on postprandial glucose were limited. Only one prior study (Crouch et al., n=20, mixed ethnicity) evaluated premeal almond load, showing a 19.4% reduction in 1-hour postprandial hyperglycemia.

**Methods:** This was a two-phase randomized crossover trial conducted at the National Diabetes, Obesity and Cholesterol Foundation, Delhi, India (January 2018–June 2021). Sixty participants (27 male, 33 female; mean age 41.3±7.9 years; 90% obese) with confirmed prediabetes were enrolled after screening 1317 individuals (1171 screen failures). Phase 1 (OGTT-based): After a 2-week run-in, participants were randomized to treatment-control or control-treatment sequence (30 per period). Treatment: 20 g almonds 30 min before 75 g oral glucose. Control: no food before OGTT. Intravenous blood was collected at −30, 0, 30, 60, 90, and 120 min for glucose, insulin, triglycerides, C-peptide, glucagon, GLP-1, and DPP-4. Phase 2 (CGMS-based): Free-living, open-label crossover. Participants wore iPro2 CGM device for 3 days. Treatment: 20 g almonds 30 min before each major meal (60 g/day). Control: standard diet without premeal almonds. CGMS recorded 288 readings/24 h. Glycemic variability (MAGE, SD, MoDD) and glycemic control parameters (mean 24-h glucose, time in range, AUC above 7.8 mmol/L, peak glucose, minimum night glucose, PPHG AUC, total AUC) were assessed. Washout period was 7 days between phases. Dietary compliance was 90%.

**Key Results:** Phase 1 (OGTT): The overall AUC (0–2 h) for blood glucose was significantly lower with premeal almond load vs. control (1057.1±101.7 vs. 1290.0±134.0, p<0.001). Mean blood glucose at 30, 60, 90, and 120 min was significantly lower (p<0.001 for all). PPHG was reduced by 18.05% in AUC on OGTT, 24.8% at 1-hour, and 28.9% at 2-hour post OGTT. Serum insulin AUC (412.2±135.6 vs. 406.2±163.8 pmol/L, p<0.001), C-peptide AUC (0.9±0.3 vs. 1.3±0.5 nmol/L, p<0.001), and plasma glucagon AUC (159.3±69.9 vs. 157.3±68.2 pmol/L, p<0.001) were significantly lower with treatment. Serum triglycerides, GLP-1, and DPP-4 did not differ significantly between diets. Phase 2 (CGMS): Premeal almond load significantly improved mean 24-h blood glucose (M) (−0.4 mmol/L, 95% CI: −0.6 to −0.3, p<0.001). Time spent above 7.8 mmol/L was lower (−0.04 h, p<0.001) with corresponding AUC reduction (−53.7 mmol/h/L, 95% CI: −78.1 to −29.2, p<0.001). Peak 24-h glucose decreased (−0.8 mmol/L, p<0.001) and minimum night glucose decreased (−0.4 mmol/L, p<0.001). PPHG AUC pp decreased by 10.07% (−51.8 mmol/h/L, 95% CI: −96.6 to −6.9, p=0.02). Overall hyperglycemia AUC total decreased (−43.3 mmol/h/L, 95% CI: −67.4 to −19.1, p<0.001). Glycemic variability improved: SD of mean glucose concentration (−0.1, p=0.02) and MoDD (−0.1, p<0.001). MAGE showed non-significant improvement (p=0.06). Basal hyperglycemia AUC did not differ (p=0.727).

**Clinical Implications:** This study demonstrates that a simple, low-cost dietary intervention—consuming 20 g of almonds 30 minutes before each major meal—significantly reduces postprandial hyperglycemia and improves multiple measures of glycemic control and variability in Asian Indians with prediabetes. The 18.05% reduction in glucose AUC on OGTT and 10.07% reduction on CGMS, along with improvements in insulin, C-peptide, and glucagon levels, suggest this strategy may help delay progression from prediabetes to T2D. Given the high prevalence of prediabetes and PPHG in Asian Indians, and the association between postprandial glucose excursions and cardiovascular risk, this intervention has broad public health implications. The findings are generalizable to the substantial population with prediabetes in India. Limitations include the short-term nature of the study (3 days CGMS), lack of formal sample size calculation for Phase 2, and the open-label design for the CGMS phase. Longer-term studies are needed to assess effects on diabetes prevention and cardiovascular outcomes.

PICO

PPOPULATION

Asian Indian adults (n=60, 27 male, 33 female, mean age 41.3 years) with prediabetes (fasting glucose 5.6–7 mmol/L and/or 2-hour plasma glucose 7.8–11.1 mmol/L after 75 g oral glucose)

IINTERVENTION

Premeal almond load: 20 g almonds consumed 30 minutes before a 75 g oral glucose load (OGTT phase) or 20 g almonds 30 minutes before each major meal (breakfast, lunch, dinner) for 3 days (CGMS phase)

OOUTCOME

Primary: postprandial blood glucose (AUC 0–2 h on OGTT; PP AUC 0–4 h on CGMS). Secondary: serum insulin, C-peptide, plasma glucagon, GLP-1, DPP-4, triglycerides (OGTT); glycemic variability (MAGE, SD, MoDD), glycemic control parameters (mean 24-h glucose, time >7.8 mmol/L, AUC >7.8 mmol/L, peak 24-h glucose, minimum night glucose) (CGMS)

STUDY TYPE

RCT

SPECIALTY

endocrinology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10169634

Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes

European Journal of Clinical Nutrition

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ABSTRACT

Abstract Background Rapid conversion from prediabetes to diabetes and frequent postprandial hyperglycemia (PPHG) is seen in Asian Indians. These should be the target of dietary strategies. Objectives We hypothesized that dietary intervention of preloading major meals with almonds in participants with prediabetes will decrease overall glycemia and PPHG. Design The study included two phases: (1) an oral glucose tolerance test (OGTT)-based crossover randomized control study, the effect of a single premeal almond load (20 g) given before OGTT was evaluated ( n = 60, 30 each period). (2) The continuous glucose monitoring system (CGMS)-based study for 3 days including premeal almond load before three major meals was a free-living, open-labeled, crossover randomized control trial, where control and premeal almond load diets were compared for glycaemic control ( n = 60, 30 in each period). The study was registered at clinicaltrials.gov (registration no. NCT04769726). Results In the OGTT-based study phase, the overall AUC for blood glucose, serum insulin, C-peptide, and plasma glucagon post-75 g oral glucose load was significantly lower for treatment vs. control diet ( p < 0.001). Specifically, with the former diet, PPHG was significantly lower (18.05% in AUC on OGTT, 24.8% at 1-h, 28.9% at 2-h post OGTT, and 10.07% during CGMS). The CGMS data showed that premeal almond load significantly improved 24-glucose variability; SD of mean glucose concentration and mean of daily differences. Daily glycaemic control improved significantly as per the following: mean 24-h blood glucose concentration (M), time spent above 7.8 mmol/L of blood glucose, together with the corresponding AUC values. Premeal almond load significantly decreased following: overall hyperglycemia (glucose AUC), PPHG, peak 24-h glycaemia, and minimum glucose level during night. Conclusion Incorporation of 20 g of almonds, 30 min before each major meal led to a significant decrease in PPHG (as revealed in OGTT-based study phase) and also improved insulin, C-peptide, glucagon levels, and improved glucose variability and glycemic parameters on CGMS in participants with prediabetes. Clinical trial registry The study was registered at clinicaltrials.gov (registration no. NCT04769726). Subject terms: Lifestyle modification, Diabetes

CITATION EXPORT

Seema Gulati, Anoop Misra, Rajneesh Tiwari et al.. Beneficial effects of premeal almond load on glucose profile on oral glucose tolerance and continuous glucose monitoring: randomized crossover trials in Asian Indians with prediabetes. European Journal of Clinical Nutrition. (2023). https://doi.org/10.1038/s41430-023-01263-1

AUTHORS

7 · 5 CENTRES

Seema Gulati, Anoop Misra, Rajneesh Tiwari, Meenu Sharma, Ravindra M Pandey, Ashish Datt Upadhyay, Hem Chandra Sati

1Diabetes Foundation (India), New Delhi, India
2National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
3Center of Nutrition & Metabolic Research (C-NET), New Delhi, India
4Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Disease, and Endocrinology, New Delhi, India
5All India Institute of Medical Sciences, New Delhi, India