Development of Low GI Composite Flour and Its Efficacy in Improving the Glycemic Profile in Type 2 Diabetes Patients _ A Randomized Clinical Trial.

The study comprises of four different phases.

• Phase 1: To develop a low GI composite flour.
• Phase 2: To assess nutritional profile and composition of the composite flour.
• Phase 3: To determine GI of chapatis made from test flour.
• Phase 4: Test the efficacy of test flour in improving glycemic profile through clinical trial.

Subjects: A total of 30 Type 2 diabetic patients aged between 30-60 years that are on oral medication will be selected for participation. They can be of either sex with no other complications of the disease. A written consent from the participants will be taken prior to study. Those participants who have insulin dependency, thyroid issues, are smokers and pregnant and lactating mothers will be excluded from the study. Prior to study, anthropometric measurements that will include height, weight, BMI, hip to waist ratio of each participant will be done. All the participants will complete testing for their HbA1c, lipid profile, fasting and random blood glucose measurements prior to study. For this, they will be called to University of Veterinary and Animal Sciences, Lahore for their blood sample collection. All the participants will be divided into two groups: control and intervention group with 15 participants in each group. The study will be conducted for 90 days and only those participants will be recruited that will be willing to complete the study duration with all the protocols for it. These include no major change in dietary pattern during the study. No change in physical activity i.e. doing any intense exercise or following any new workout routines. No change in medications or supplements during the study period is recommended.

Experimental design: The participants in the intervention group will be provided test flour for their chapattis (2kg for 10 days). The flour will be provided after each 10 days and they will be asked to use this flour for their chapattis. They will be guided to consume at least 3-4 chapattis each day while the participants in the control group will be asked to continue the flour, they are already using for their chapatti making. However during the study period all the participants will continue to follow their regular dietary habits, physical activity patterns and will continue taking their diabetes medication as per their schedule.

Biochemical testing: Along with the anthropometry, the participants will be tested biochemically by taking their blood samples at the start and at the end of the study. Before starting the trial, each participant will be tested for HbA1c and lipid profile. HbA1c tests will be done by Ion Exchange Resin method by using Glycohemoglobin HbA1 kit of brand Human Diagnostics. Lipid profile will also be checked at the baseline and after 3 months. For this purpose, Human diagnostic Kit will be used i.e. cholesterol liquicolor kit for cholesterol assessment, HDL cholesterol kit by Human diagnostics for HDL measurement, LDL liquicolor kit and TG Liquicolor mono kit by Human Diagnostics for LDL and triglycerides assessment. Random and Fasting blood glucose levels will be checked after every 10 days by using finger prick method through Glucometer (ACCU-CHECK® Performa Nano, Mannhim, Germany). For their interpretation, Guidelines of National Cholesterol Education Program (NCEP), (2004) will be used.