Comment on: Wolpert et al. Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for Carbohydrate-Based Bolus Dose Calculation and Intensive Diabetes Management. Diabetes Care 2013;36:810–816

I read with great interest the recent article by Wolpert et al. (1) in which they compared postprandial responses elicited by low- and high-fat dinner test meals and concluded that dietary fat increases glucose levels and insulin requirements in people with type 1 diabetes. This is consistent with recent results of ours showing that adding 20 g of fat as margarine to 110 g of bread (50 g starch) reduced the glycemic response in subjects without diabetes, but, if anything, tended to increase postprandial glucose in subjects with type 1 diabetes (2). We may have been unable to detect a significant increase in postprandial glucose because we added less than half the amount of fat to the test meal compared with Wolpert et al. (20 g vs. 50 g). Although Wolpert et al. performed a much more detailed, well-controlled, and sophisticated study than we did, they gave few details about the composition of the test meals; this makes comparison of their results with others in the literature difficult. Therefore, would Wolpert et al. please indicate the mean weight of the various foods in the low- and high-fat dinner test meals; the mean amounts of carbohydrate, dietary fiber, and protein; and, if possible, the nature of the fat they contained?