title: Resistant starch lowers postprandial glucose and leptin in overweight adults consuming a moderate-to-high-fat diet: a randomized-controlled trial [Effects of resistant starch on insulin resistance of type 2 diabetes mellitus patients]. Efficacy of increased resistant starch consumption in human type 2 diabetes Increased gut hormones and insulin sensitivity index following a 3-d intervention with a barley kernel-based product: a randomised cross-over study in healthy middle-aged subjects. Resistant dextrin, as a prebiotic, improves insulin resistance and inflammation in women with type 2 diabetes: a randomised controlled clinical trial. Resistant Starch Bagels Reduce Fasting and Postprandial Insulin in Adults at Risk of Type 2 Diabetes. The Therapeutic Potential of Resistant Starch in Modulation of Insulin Resistance, Endotoxemia, Oxidative Stress and Antioxidant Biomarkers in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial Dietary treatment with rice containing resistant starch improves markers of endothelial function with reduction of postprandial blood glucose and oxidative stress in patients with prediabetes or newly diagnosed type 2 diabetes. Prior short-term consumption of resistant starch enhances postprandial insulin sensitivity in healthy subjects Is there any place for resistant starch, as alimentary prebiotic, for patients with type 2 diabetes?
abstract: Background High-amylose maize resistant starch type 2 ( HAM-RS2 ) stimulates gut-derived satiety peptides and reduces adiposity in animals . Human studies have not supported these findings despite improvements in glucose homeostasis and insulin sensitivity after HAM-RS2 intake which can lower adiposity-related disease risk . The primary objective of this study was to evaluate the impact of HAM-RS2 consumption on blood glucose homeostasis in overweight , healthy adults . We also examined changes in biomarkers of satiety ( glucagon-like peptide-1 [ GLP-1 ] , peptide YY [ PYY ] , and leptin ) and body composition determined by anthropometrics and dual-energy x-ray absorptiometry , dietary intake , and subjective satiety measured by a visual analogue scale following HAM-RS2 consumption . Methods Using a r and omized-controlled , parallel-arm , double-blind design , 18 overweight , healthy adults consumed either muffins enriched with 30 g HAM-RS2 ( n = 11 ) or 0 g HAM-RS2 ( control ; n = 7 ) daily for 6 weeks . The HAM-RS2 and control muffins were similar in total calories and available carbohydrate . Results At baseline , total PYY concentrations were significantly higher 120 min following the consumption of study muffins in the HAM-RS2 group than control group ( P = 0.043 ) . Within the HAM-RS2 group , the area under the curve ( AUC ) glucose ( P = 0.028 ) , AUC leptin ( P = 0.022 ) , and postpr and ial 120-min leptin ( P = 0.028 ) decreased independent of changes in body composition or overall energy intake at the end of 6 weeks . Fasting total PYY increased ( P = 0.033 ) in the HAM-RS2 group , but changes in insulin or total GLP-1 were not observed . Mean overall change in subjective satiety score did not correlate with mean AUC biomarker changes suggesting the satiety peptides did not elicit a satiation response or change in overall total caloric intake . The metabolic response from HAM-RS2 occurred despite the habitual intake of a moderate-to-high-fat diet ( mean range 34.5 % to 39.4 % of total calories ) . Conclusion Consuming 30 g HAM-RS2 daily for 6 weeks can improve glucose homeostasis , lower leptin concentrations , and increase fasting PYY in healthy overweight adults without impacting body composition and may aid in the prevention of chronic disease . However , between-group differences in biomarkers were not observed and future research is warranted before specific recommendations can be made . Trial registration None OBJECTIVE To observe the effects of resistant starch ( RS ) on insulin resistance ( IR ) in type 2 diabetes mellitus patients . METHODS All 40 patients with type 2 diabetes mellitus were r and omly divided into two groups : Group A and Group B. Cross- design of two stages ( I , II ) was used during observation . Group A received RS 30 g/d as an intervention group for ahead of 4 weeks ( I stage ) , while group B as a control group . Group B was given RS in late 4 weeks ( II stage ) , while Group A as served control group . Blood was taken the first day and on the latest day in each stage . Fasting blood glucose ( FBG ) , post blood glucose ( PBG ) , fructosamine ( FMN ) , total cholesterol ( TC ) , triglyceridemic ( TG ) , insulin sensitive index ( ISI ) , and body mass index ( BMI ) were measured , respectively . RESULTS As Compared with the control group , ISI was higher and FBG , PBG , TC , TG , FMN and BMI were significantly lower in intervention group ( P < 0.05 ) . CONCLUSION RS should be effective in improving IR of type 2 diabetes mellitus patients Resistant starch ( RS ) has been shown to beneficially affect insulin sensitivity in healthy individuals and those with metabolic syndrome , but its effects on human type 2 diabetes ( T2DM ) are unknown . This study aim ed to determine the effects of increased RS consumption on insulin sensitivity and glucose control and changes in postpr and ial metabolites and body fat in T2DM . Seventeen individuals with well-controlled T2DM ( HbA1c 46.6±2 mmol/mol ) consumed , in a r and om order , either 40 g of type 2 RS ( HAM-RS2 ) or a placebo  , daily for 12 weeks with a 12-week washout period in between . At the end of each intervention period , participants attended for three metabolic investigations : a two-step euglycemic – hyperinsulinemic clamp combined with an infusion of [ 6,6 - 2H2 ] glucose , a meal tolerance test ( MTT ) with arterio-venous sampling across the forearm , and whole-body imaging . HAM-RS2 result ed in significantly lower postpr and ial glucose concentrations ( P=0.045 ) and a trend for greater glucose uptake across the forearm muscle ( P=0.077 ) ; however , there was no effect of HAM-RS2 on hepatic or peripheral insulin sensitivity , or on HbA1c . Fasting non-esterified fatty acid ( NEFA ) concentrations were significantly lower ( P=0.004 ) and NEFA suppression was greater during the clamp with HAM-RS2 ( P=0.001 ) . Fasting triglyceride ( TG ) concentrations and soleus intramuscular TG concentrations were significantly higher following the consumption of HAM-RS2 ( P=0.039 and P=0.027 respectively ) . Although fasting GLP1 concentrations were significantly lower following HAM-RS2 consumption ( P=0.049 ) , postpr and ial GLP1 excursions during the MTT were significantly greater ( P=0.009 ) . HAM-RS2 did not improve tissue insulin sensitivity in well-controlled T2DM , but demonstrated beneficial effects on meal h and ling , possibly due to higher postpr and ial GLP1 Certain purified indigestible carbohydrates such as inulin have been shown to stimulate gut-derived hormones involved in glycaemic regulation and appetite regulation , and to counteract systemic inflammation through a gut microbiota-mediated mechanism . Less is known about the properties of indigestible carbohydrates intrinsic to food . The aim of this study was to investigate the possibility to affect release of endogenous gut hormones and ameliorate appetite control and glycaemic control by ingestion of a whole-grain cereal food product rich in NSP and resistant starch in healthy humans . In all , twenty middle-aged subjects were provided with a barley kernel-based bread ( BB ) or a reference white wheat bread during 3 consecutive days , respectively , in a r and omised cross-over design study . At a st and ardised breakfast the following day ( day 4 ) , blood was collected for the analysis of blood ( b ) glucose regulation , gastrointestinal hormones , markers of inflammation and markers of colonic fermentation ; 3 d of intervention with BB increased gut hormones in plasma ( p ) the next morning at fasting ( p-glucagon-like peptide-1 ; 56 % ) and postpr and ially ( p-glucagon-like peptide-2 ; 13 % and p-peptide YY ; 18 % ) . Breath H₂ excretion and fasting serum ( s ) SCFA concentrations were increased ( 363 and 18 % , respectively ) , and b-glucose ( 22 % ) and s-insulin responses ( 17 % ) were decreased after BB intervention . Insulin sensitivity index ( ISI(composite ) ) was also improved ( 25 % ) after BB . In conclusion , 3 d of intervention with BB increased systemic levels of gut hormones involved in appetite regulation , metabolic control and maintenance of gut barrier function , as well as improved markers of glucose homoeostasis in middle-aged subjects , altogether relevant for the prevention of obesity and the metabolic syndrome Improvement of insulin resistance and inflammation is a basic strategy in the management of type 2 diabetes . There is limited evidence that prebiotics improve insulin resistance and inflammation . However , the ameliorating effect of resistant dextrin , as a prebiotic , on insulin resistance and inflammation in patients with type 2 diabetes has not been investigated so far . Therefore , the present study aim ed to examine the effects of resistant dextrin on insulin resistance and inflammation in type 2 diabetic patients . In a r and omised controlled clinical trial , fifty-five women with type 2 diabetes were assigned to two groups : the intervention group ( n 30 ) and the control group ( n 25 ) . The intervention group received a daily supplement of 10 g resistant dextrin and the control group received a similar amount of maltodextrin as placebo for 8 weeks . Fasting plasma glucose ( FPG ) , HbA1c , insulin , high-sensitivity C-reactive protein ( hs-CRP ) , IL-6 , TNF-α , malondialdehyde ( MDA ) and serum endotoxin concentrations were measured before and after the intervention . Data were analysed using SPSS ( version 13 ) . Paired and unpaired t tests and ANCOVA were used to compare quantitative variables after the intervention . Patients supplemented with resistant dextrin exhibited a significant decrease in fasting insulin ( 20.1 pmol/l , 22.8 % ) , homeostasis model assessment of insulin resistance ( 1.3 , 24.9 % ) , quantitative insulin sensitivity check index ( 0.2 , 7.2 % ) , IL-6 ( 1.4 pg/ml , 28.4 % ) , TNF-α ( 5.4 pg/ml , 18.8 % ) , MDA ( 1.2 nmol/ml , 25.6 % ) and endotoxin ( 6.2 endotoxin units/ml , 17.8 % ) concentrations than those supplemented with maltodextrin ( P < 0.05 ) . Decreases in FPG ( 0.05 mmol/l , 0.6 % ) , HbA1c ( 0.5 % , 9.6 % ) and hs-CRP ( 2.7 ng/ml , 35.1 % ) concentrations in the resistant dextrin group were not significant when compared with the maltodextrin group . In conclusion , resistant dextrin supplementation can modulate inflammation and improve insulin resistance in women with type 2 diabetes BACKGROUND Type 2 diabetes ( T2D ) incidence continues to rise . Although increasing dietary fiber intake is an established strategy for improved glycemic control , most adults consume insufficient amounts . Fiber-enhanced functional foods can increase fiber intake , and there is particular interest in resistant starch ( RS ) as a high-fiber ingredient . Studies show that high-amylose maize resistant starch , type 2 ( HAM-RS2 ) improves acute and chronic glycemic responses , but more studies are needed in individuals at high risk of T2D with RS delivered in commonly consumed foods . OBJECTIVE The objective of this study was to examine the chronic effects of consuming bagels high in HAM-RS2 on fasting and postpr and ial glycemic markers in adults at increased risk of T2D . METHODS With the use of a r and omized , double-blind crossover design , 24 men and women with a mean ± SE age of 55.3 ± 1.59 y and body mass index ( in kg/m2 ) of 30.2 ± 0.57 consumed 1 bagel containing 25 g HAM-RS2/d or 1 control wheat bagel/d for 56 d each , separated by a 4-wk washout . Fasting and postpr and ial oral-glucose-tolerance test ( OGTT ) glucose and insulin were measured on study days 1 and 57 of each bagel treatment . RESULTS The RS bagel treatment result ed in significantly lower fasting ( 22.1 % , P = 0.04 ) , 2-h ( 23.3 % , P < 0.008 ) , and 3-h ( 18.9 % , P = 0.05 ) insulin incremental areas under the curve and fasting insulin resistance ( homeostasis model assessment of insulin resistance ; 23.1 % , P = 0.04 ) than did the control bagel treatment . Fasting and postpr and ial OGTT glucose concentrations did not differ between the RS and control bagel treatments on study days 1 or 57 . CONCLUSIONS These data suggest that consumption of a high-HAM-RS2 bagel improves glycemic efficiency by reducing the amount of insulin required to manage postpr and ial glucose while improving fasting insulin sensitivity in adults at increased risk of T2D . This research provides support for a feasible dietary strategy for T2D risk reduction . This trial was registered at clinical trials.gov as NCT02129946 Aims : This trial aims to determine the effects of resistant starch ( RS ) subtype 2 ( RS2 ) on glycemic status , metabolic endotoxemia and markers of oxidative stress . Methods : A r and omized , controlled , parallel-group clinical trial group of 56 females with type 2 diabetes mellitus ( T2DM ) was divided to 2 groups . The intervention group ( n = 28 ) and control group ( n = 28 ) received 10 g/day RS2 or placebo for 8 weeks , respectively . Fasting blood sample s were taken to determine glycemic status , endotoxin , high sensitivity C-reactive protein ( hs-CRP ) , malondialdehyde ( MDA ) , total antioxidant capacity ( TAC ) , antioxidant enzymes concentrations as well as uric acid at baseline and after the intervention . Results : After 8 weeks , RS2 caused a significant decrease in the levels of MDA ( -34.10 % ) , glycosylated hemoglobin ( -9.40 % ) , insulin ( -29.36 % ) , homeostasis model of insulin resistance ( -32.85 % ) and endotoxin ( -25.00 % ) , a significant increase in TAC ( 18.10 % ) and glutathione peroxidase ( 11.60 % ) as compared with control . No significant changes were observed in fasting plasma glucose , quantitative insulin sensitivity check index , hs-CRP , superoxide dismutase , catalase and uric acid in the RS2 group as compared with the control group . Conclusion : Supplementation with RS2 may be improved glycemic status , endotoxemia and markers of oxidative stress in patients with T2DM OBJECTIVE We aim ed to evaluate whether 4-week of dietary treatment with rice containing resistant starch reduces blood glucose and oxidative stress as well as improves endothelial function . METHODS Patients with impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) or newly diagnosed type 2 diabetes ( n = 90 ) were r and omly assigned to either a group ingesting rice containing 6.51 g resistant starch daily or a control rice group for 4-weeks . We assessed fasting and postpr and ial levels of glucose and insulin , oxidative stress markers and endothelial function using reactive hyperemia peripheral arterial tonometry  ( RH-PAT ) . RESULTS The diet containing rice with resistant starch  reduced fasting insulin and insulin resistance , postpr and ial glucose ( P = 0.010 ) and insulin levels at 30 min , and glucose and insulin areas under the response curve after the st and ard meal . Rice with resistant starch also decreased urinary 8-epi-PGF(2α ) and plasma malondialdehyde ( MDA ) and increased the RH-PAT index ( P < 0.001 ) and total nitric oxide ( NO ) . Postpr and ial changes in glucose at 60 and 120 min and areas under the glucose response curve , MDA , RH-PAT , and total NO of the test group differed significantly from those in the control even after adjusting for baseline values . Overall , changes in the RH-PAT index correlated positively with changes in total NO ( r = 0.336 , P = 0.003 ) and superoxide dismutase activity ( r = 0.381 , P = 0.001 ) and negatively with changes in MDA ( r = -0.358 , P = 0.002 ) and 8-epi-PGF(2α ) . CONCLUSIONS In patients with IFG , IGT or newly diagnosed type 2 diabetes , 4-weeks of dietary treatment with rice containing resistant starch was associated with improved endothelial function with reduction of postpr and ial glucose and oxidative stress compared with control Aims /hypothesisDiets rich in insoluble-fibre are linked to a reduced risk of both diabetes and cardiovascular disease ; however , the mechanism of action remains unclear . The aim of this study was to assess whether acute changes in the insoluble-fibre ( resistant starch ) content of the diet would have effects on postpr and ial carbohydrate and lipid h and ling . Methods Ten healthy subjects consumed two identical , low-residue diets on separate occasions for 24 h ( 33 % fat ; < 2 g dietary fibre ) . Of the diets one was supplemented with 60 g resistant starch ( Novelose 260 ) . On the following morning a fibre-free meal tolerance test ( MTT ) was carried out ( 59 g carbohydrate ; 21 g fat ; 2.1 kJ ) and postpr and ial insulin sensitivity ( SIORAL ) assessed using a minimal model approach . Results Prior resistant starch consumption led to lower postpr and ial plasma glucose ( p=0.037 ) and insulin ( p=0.038 ) with a higher insulin sensitivity(44±7.5 vs 26±3.5 × 10−4 dl kg−1 min−1 per µUml−1 ; p=0.028 ) and C-peptide-to-insulin molar ratio ( 18.7±6.5 vs 9.7±0.69 ; p=0.017 ) . There was no effect of resistant starch consumption on plasma triacylglycerol although non-esterified fatty acid and 3-hydroxybutyrate levels were suppressed 5 h after the meal tolerance test . Conclusion Prior acute consumption of a high-dose of resistant starch  enhanced carbohydrate h and ling in the postpr and ial period the following day potentially due to the increased rate of colonic fermentation OBJECTIVE The aim of the present study was to determine effects of Resistant Starch ( RS2 ) on metabolic parameters and inflammation in women with type 2 diabetes ( T2DM ) . METHODS In this r and omized controlled clinical trial , 60 females with T2DM were divided into intervention ( n = 28 ) and placebo groups ( n = 32 ) . They received 10 g/d RS2 or placebo for 8 weeks , respectively . Fasting blood sugar ( FBS ) , glycated hemoglobin ( HbA1c ) , lipid profile , high-sensitive C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) and tumor necrosis factor-alpha ( TNF-α ) were measured at baseline and at the end of the trial . Paired t test , unpaired t-test and ANCOVA were used to compare the quantitative variables . The data were analyzed using SPSS software version 13.0 . RESULTS RS2  decreased HbA1c ( -0.3 % , -3.6 % ) , TNF-α ( -3.4 pg/mL , -18.9 % ) , triglyceride ( -33.4 mg/dL , -15.4 % ) , and it increased HDL-c ( + 9.4 mg/dL , + 24.6 % ) significantly compared with the placebo group ( p < 0.05 ) . Changes in FBS , total cholesterol , low-density lipoprotein , hs-CRP and IL-6 were not significant in the RS2 group compared with the control group . RS2 can improve glycemic status , inflammatory markers and lipid profile in women with T2DM . CONCLUSIONS Although findings of the present study indicated positive effects of RS2  on inflammation and metabolic parameters , more studies are needed to confirm efficacy of RS2 as an adjunct therapy in diabetes
target: The results indicated that there was no significant difference in the amelioration of BMI , HOMA-%S and HOMA-%B in T2DM patients between RS and the non-RS supplementation .
  There was no significant difference between RS and non-RS supplements in patients with simple obesity .
  Conclusion RS supplementation can ameliorate IR in T2DM , especially for the patients of T2DM with obesity , but not in simple obesity
background: Background Resistant starch ( RS ) is a starch that can be fermented by the microbial flora within gut lumen .
  Insulin resistance ( IR ) is a pathophysiological condition related to diabetes and obesity .
  RS could reduce blood glucose and ameliorate IR in animals , but its effect in human population is controversial .
  Objective The authors conducted a systematic literature review to evaluate the effect of RS diet supplement on ameliorating IR in patients with T2DM and simple obesity .