Glycaemic, insulin and ghrelin responses to traditional South Asian flatbreads in diabetic and healthy subjects

In the South-East Asian subcontinent, flatbreads contribute the main portion of carbohydrate to a meal. There are no specific data on the effect of different flatbreads on satiety and recurrent hunger, as indicated by the duration of ghrelin suppression after a meal. The present study was designed to examine the glycaemic, insulin and ghrelin responses to traditional subcontinental breads in type 2 diabetic subjects and healthy volunteers. For this purpose, twelve normoglycaemic healthy volunteers and ten type 2 diabetic patients, in the fasting state, consumed one of five common flatbreads on consecutive days. Capillary blood glucose was examined in the fasting state and serially for 5 h after a meal. Serum insulin and ghrelin levels were determined at hourly intervals for 5 h after the consumption of bran and plain chapatti flatbreads. The incremental area under the curve (iAUC) was calculated for glycaemic and insulin responses, while the net AUC was used to assess the ghrelin response. The results showed that glycaemic and insulin iAUC were lowest for bran chapatti, and highest for plain chapatti. Furthermore, bran chapatti showed maximum ghrelin suppression in both normal and diabetic groups. In conclusion, the low-glycaemic index bran chapatti flatbread had a lower postprandial glycaemic excursion and insulin response, and a more prolonged suppression of ghrelin levels, compared with the plain chapatti flatbread, and in each case, the difference was greater for the diabetic subjects than for the normal subjects. The inclusion of these flatbreads in the diabetic/weight-reducing diet may help weight loss by promoting satiety and reducing hyperinsulinaemia.