{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:20:12Z","timestamp":1775064012273,"version":"3.50.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Gestational diabetes mellitus (GDM) poses significant risks to both maternal and fetal health, including a heightened risk of developing type 2 diabetes (T2DM) in the future. Effective management often involves dietary changes, such as food-order, where vegetables are consumed first, followed by proteins, and then carbohydrates last. This study investigates whether food sequence improves glycemic control in women with GDM by slowing carbohydrate absorption, reducing glucose spikes, and enhancing insulin sensitivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty-five women with GDM participated in a four-week trial with three phases: baseline measurement (week 0), phase 1 (regular diet), and phase 2 (food-order) intervention. Primary outcomes were blood glucose and serum insulin levels, measured at fasting, 1-h, and 2-h postprandial intervals during each phase. In phase 1 (weeks 0\u20132), participants followed their usual diet. In phase 2 (weeks 2\u20134), the same participants followed a food-order regimen: vegetables first, then proteins, and carbohydrates last. Customized meal plans for vegetarians and non-vegetarians were provided. Participants were monitored via a mobile application (Jotform) for adherence. Follow-up blood glucose and insulin were measured before, and 60 and 120\u202fmin after, consuming a standardized meal (339\u202fkcal, 16.4\u202fg protein, 56.1\u202fg carbohydrates, 3.4\u202fg fat) in the clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The food-order intervention resulted in a significant reduction in postprandial blood glucose by 5.87% (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001) at 60\u202fmin and 6.06% (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001) at 120\u202fmin. Also, Serum insulin levels decreased by 8.13% (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001) at 60\u202fmin and 11.10% (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001) at 120\u202fmin, compared to the regular diet. These results suggest improved metabolic control and insulin sensitivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prioritizing vegetables before protein and carbohydrates improves glycemic control and insulin sensitivity in women with GDM. This simple strategy helps regulate blood glucose and may reduce the long-term risk of T2DM. It offers a practical approach to managing GDM, but further research with larger cohorts and longer interventions is needed to assess its long-term effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>https:\/\/ctri.nic.in\/Clinicaltrials\/regtrial.php?modid=1&amp;amp;compid=19&amp;amp;EncHid=81473.12293<\/jats:ext-link>, identifier CTRI\/2024\/01\/061220.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2024.1512231","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T05:11:39Z","timestamp":1735017099000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Food order affects blood glucose and insulin levels in women with gestational diabetes"],"prefix":"10.3389","volume":"11","author":[{"given":"Ria","family":"Murugesan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janardanan","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shubhashree","family":"Thiruselvam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kakithakara Vajravelu","family":"Leela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Geetha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhishek","family":"Satheesan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venkata","family":"Chaithanya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matcha","family":"Angelin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"399","DOI":"10.15537\/smj.2015.4.10307","article-title":"Gestational diabetes mellitus","volume":"36","author":"Alfadhli","year":"2015","journal-title":"Saudi Med J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/17446651.2018.1476135","article-title":"Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review","volume":"14","author":"Farahvar","year":"2019","journal-title":"Expert Rev Endocrinol Metab"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"56","DOI":"10.3389\/fendo.2017.00056","article-title":"The challenges and recommendations for gestational diabetes mellitus care in India: a review","volume":"8","author":"Morampudi","year":"2017","journal-title":"Front Endocrinol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/978-3-319-56440-1_32","article-title":"Diet and carbohydrate food knowledge in gestational diabetes: challenges and opportunities for lifestyle interventions","volume-title":"Nutrition and diet in maternal diabetes. Nutrition and health","author":"Ali","year":"2018"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3164\/jcbn.13-67","article-title":"Effect of eating vegetables before carbohydrates on glucose excursions in patients with type 2 diabetes","volume":"54","author":"Imai","year":"2014","journal-title":"J Clin Biochem Nutr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3813","DOI":"10.52783\/jchr.v14.i2.4309","article-title":"The crucial role of diet in managing gestational diabetes mellitus: a review","volume":"14","author":"Murugesan","year":"2024","journal-title":"J Chem Health Risks"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.2337\/dc15-0429","article-title":"Food order has a significant impact on postprandial glucose and insulin levels","volume":"38","author":"Shukla","year":"2015","journal-title":"Diabetes 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insulin response to meal sequence among healthy UAE adults: a randomized controlled crossover trial","volume":"17","author":"Shaheen","year":"2024","journal-title":"Diabetes Metab Syndr Obes"},{"key":"ref15","volume-title":"Assessment: anything, anywhere, anytime using Jotform","author":"Ajmi","year":"2016"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e51658","DOI":"10.2196\/51658","article-title":"Effectiveness of the QuitSure smartphone app for smoking cessation: findings of a prospective single arm trial","volume":"7","author":"Pandya","year":"2023","journal-title":"JMIR Form Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"67","DOI":"10.15294\/teknobuga.v12i1.50229","article-title":"Child development measurement instrument based on digital format at the childcare 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mellitus","volume":"2022","author":"Yong","year":"2022","journal-title":"J Diabetes Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1007\/s40618-018-0975-0","article-title":"Evaluating the effects of mobile health intervention on weight management, glycemic control and pregnancy outcomes in patients with gestational diabetes mellitus","volume":"42","author":"Guo","year":"2019","journal-title":"J Endocrinol Investig"}],"container-title":["Frontiers in 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