Treatment of Reactive Hypoglycemia with the Macrobiotic Ma-Pi 2 Diet as Assessed by Continuous Glucose Monitoring: the MAHYP Randomized Crossover Trial

• Published in: Metabolism, clinical and experimental Vol. 69; pp. 148 - 156
• Main Authors: Soare, Andreea, Khazrai, Yeganeh Manon, Fontana, Lucia, Del Toro, Rossella, Lazzaro, Maria Concetta, Di Rosa, Claudia, Buldo, Antonia, Fioriti, Elvira, Maddaloni, Ernesto, Angeletti, Silvia, Di Mauro, Antonio, Gesuita, Rosaria, Skrami, Edlira, Tuccinardi, Dario, Fallucca, Sara, Pianesi, Mario, Pozzilli, Paolo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adult; Blood Glucose - analysis; Blood Glucose Self-Monitoring; Body Mass Index; Body Weight; Continuous glucose monitoring; Cross-Over Studies; Diet, Macrobiotic; Endocrinology & Metabolism; Female; Humans; Hypoglycemia - diet therapy; Macrobiotic Ma-pi 2 diet; Male; Middle Aged; Reactive hypoglycemia; Snacks; Treatment Outcome; Type-2 diabetes; oral glucose tolerance test; T1D; ITT; American diabetes association; IFG; intention-to-treat; CIs; MC group; mixed meal test; macrobiotic Ma-Pi 2 diet; AEs; impaired fasting glucose; control diet first and Ma-Pi 2 diet then; Ma-Pi 2 diet first and control diet then; BMI; glycemic index; GI; CM group; type-2 diabetes; body mass index; T2D; CGM; Reactive hypoglycemia; MMT; RH; adverse effects; SCFAs; confidence intervals; continuous glucose monitoring; OGTT; type-1 diabetes; ADA; short chain fatty acids; Type-2 diabetes; Continuous glucose monitoring; Macrobiotic Ma-pi 2 diet
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2017.01.023

Abstract Background and Aims Nutritional therapy is recommended for management of reactive hypoglycemia (RH), a condition characterised by hypoglycemia that occurs within four hours after a meal. The macrobiotic Ma-Pi 2 diet improves glycemic control in subjects with type 2 diabetes. We explored the effect of this diet on outcomes in non-diabetic individuals with RH. Materials and Methods Twelve subjects with RH were randomized to the Ma-Pi 2 diet for three days and a control diet for three days in a randomized crossover design. Subjects received snacks on two days out of each three-day period only, and were monitored using continuous glucose monitoring. The 24-h period was divided into daytime (08:00–22:30 h [subdivided into ‘daytime without snacks’ and ‘daytime with snacks’]) and night-time (22:31–07:59 h). The effects of the two diets on the number of RH events (blood glucose < 70 mg/dL [3.9 mmol/L]) and the percentage distribution of glucose readings within each of 16 glycemic intervals from < 40 mg/dL (2.2 mmol/L) to > 180 mg/dL (4.4 mmol/L) were determined. Results There were significantly fewer RH events on the Ma-Pi 2 diet than the control diet during daytime without snacks (− 2.5 events; 95% CI: -7.5, 0.0; P = 0.022) and daytime with snacks (− 4.25 events; 95% CI: -7.5; − 2.0; P = 0.013) but no difference at night. The percentage of glucose readings in the interval 71–80 mg/dL (3.9–4.4 mmol/L) was significantly higher on the control diet during daytime with and without snacks ( P = 0.03 for both), while the percentage of glucose readings in the interval 91–100 mg/dL (5.1–5.6 mmol/L) was significantly higher on the Ma-Pi 2 diet during daytime without snacks ( P = 0.02). Conclusions The macrobiotic Ma-Pi 2 diet reduced blood glucose excursions during the day, thereby facilitating glycemic control in subjects with RH. The Ma-Pi 2 diet represents an effective nutritional tool for management of RH.