Subject of my thesis

Title: Glycaemic control and cardiometabolic profile in type 2 diabetes: impact of starch digestibility

In 2021, around 537 million adults worldwide will suffer from diabetes, 90% of which will be type 2 diabetes (T2DM). T2DM results from the development of insulin resistance, characterised by body cells that do not respond to insulin, leading to a high concentration of glucose in the blood. Hyperglycaemia is implicated in the development of complications associated with T2DM, and glycaemic variability (GV) measured using CGMS (Continuous Glucose Monitoring System) is now emerging as an integral component of glucose homeostasis, alongside HbA1c, fasting and postprandial blood glucose levels. In addition, many parameters of glycaemic variability are correlated with the cardiovascular complications of diabetes independently of HbA1c, making glycaemic variability an integral component of the parameters to be taken into account in dysglycaemia in T2DM. To compensate for this, the quality of carbohydrates has been highlighted as having a decisive impact on glycaemic excursions. In particular, the digestibility of starch-based products could have an impact on glycaemic control in T2DM, as the CRNH-RA team has shown in healthy subjects and those at metabolic risk that a diet rich in Slowly Digestible Starch (SDS) improves glycaemic control. In fact, starch is a major daily source of carbohydrates, which account for around 50-70% of the daily energy intake. The CRNH-RA team recently demonstrated that a short one-week diet rich in SDS had a significant beneficial impact on glycaemic variability as assessed by CGMS compared with a conventional diet. In addition, a fraction of starch, Resistant Starch (RS), has also been shown to have an impact on human health and glycaemic levels. Like dietary fibre, this non-digestible fraction interacts with the intestinal microbiota and induces the production of various metabolites that can then modulate intestinal barrier function, inflammatory parameters and carbohydrate and lipid metabolism. The aim of this thesis is to assess the impact of modulating starch digestibility on glycaemic variability and control as well as cardio-metabolic and inflammatory profiles in type 2 diabetic patients.