(P07-041-20) Ground-Breaking Application of Raw Corn Starch-Based Diet in Patients with Insulinoma-Related Hypoglycemia: A Before-After Prospective Study

Objectives: Raw corn starch (RCS), as a source of slow release carbohydrate, has been used to counter the hypoglycemia caused by glycogen storage diseases. Further, the utilization of RCS in other conditions has rarely been studied. Insulinoma, a rare neuroendocrine tumor, tends to lead to life-threatening hypoglycemia as well as hyperphagia that often contribute to severe obesity. To the best of our knowledge, this is the first study to demonstrate the efficacy and safety of an RCS-based diet to control insulinoma-related hypoglycemia.

Methods: In this single-arm prospective clinical study, 28 in-patients with unoperated insulinoma were enrolled at Peking Union Medical College Hospital from March 1st, 2017 to September 30th, 2018. The intervention included education and guidance of an RCS-based structured diet comprising complex carbohydrate that provided 60%~70% of patients’ caloric intake. RCS constituted 30%~50% of daily carbohydrate intake, and was supplemented regularly between meals or every 4 hours overnight, in doses of 20g~50g per time. Clinical parameters were supervised before and after the intervention to evaluate its efficacy and safety.

Results: Twenty-eight patients (8 males) with insulinoma, with a mean age of 47.6±14 years, received the RCS-based nutritional management. During post-intervention period, both FBG (3.30±0.91 mmol/L) at 1 week and FBG (3.07±0.77 mmol/L) at over 4 weeks of follow up, were all significantly higher than pre-intervention FBG (2.27±0.64 mmol/L) (P =0.000). Frequency of hypoglycemic attacks and reports of hypoglycemic symptoms (especially autonomic symptoms (fatigue, sense of hunger)) were also reduced on RCS-based diet. Compared with obvious weight gain (4.07±2.04 kg/month) in all cases before intervention, RCS-based diet prevented the ponderal growth induced by overeating in 76.9% of patients. In terms of safety, mild gastrointestinal discomfort was reported as the most common adverse reaction, but relieved when RCS doses were slightly reduced.

Conclusions: An RCS-based diet constitutes an effective, well tolerated and non-invasive therapy to counter insulinoma-related hypoglycemia.

Funding Sources: This study was supported by the the Fundamental Research Funds for the Central Universities (grant number: 3332018014), and the Project of Science and Technology of Beijing (grant number: Z191100008619006)