Lower postprandial glucose responses at baseline and after 4 weeks use of a diabetes-specific formula in diabetes type 2 patients.

AIMS: To determine whether lower postprandial glucose (PPG) levels after intake of a diabetes-specific formula (DSF) compared with a standard formula were maintained after 4 weeks use. METHODS: Randomized, controlled, double-blind, parallel-group study. Forty-four type 2 diabetes patients on oral anti-diabetes medication consumed 2×200mL/day of a DSF (Diasip(®)) or an isocaloric standard, fiber-containing formula for 4 weeks. PPG responses were assessed at baseline and after 4 weeks by iAUC and (delta) peak glucose concentrations. RESULTS: PPG response was significantly lower in the DSF group after first intake and remained significantly lower after 4 weeks use. Postprandial insulin, fasting glucose, insulin resistance, fructosamine and lipid levels did not differ between groups after 4 weeks. Within the standard group, fasting glucose and HOMA(IR) significantly increased over the intervention period. Changes in body weight between groups were significantly different, with an increase in the standard group. Both products were equally well tolerated. CONCLUSIONS: Superior PPG control by DSF was maintained after 4 weeks use, showing that this formula has added value with respect to PPG control for type 2 diabetes patients compared to a standard, fiber-containing formula. The observed effects on body weight, fasting glucose and HOMA(IR) may further support the use of a DSF.

Tube feeding with a diabetes-specific feed for 12 weeks improves glycaemic control in type 2 diabetes patients.

BACKGROUND AND AIMS: Assess longer-term (12 weeks) effects of a diabetes-specific feed on postprandial glucose response, glycaemic control (HbA1c), lipid profile, (pre)-albumin, clinical course and tolerance in diabetic patients. METHODS: In this randomized, controlled, double-blind, parallel group study 25 type 2 diabetic patients on tube feeding were included. Patients received a soy-protein based, multi-fibre diabetes-specific feed or isocaloric, fibre-containing standard feed for 12 weeks, while continuing on their anti-diabetic medication. At the beginning, after 6 and 12 weeks, several (glycaemic) parameters were assessed. RESULTS: The postprandial glucose response (iAUC) to the diabetes-specific feed was lower at the 1st assessment compared with the standard feed (p=0.008) and this difference did not change over time. HbA1c decreased over time in the diabetes-specific and not in the standard feed group (treatment*time:p=0.034): 6.9+/-0.3% (mean+/-SEM) at baseline vs. 6.2+/-0.4% at 12 weeks in the diabetes-specific group compared to 7.9+/-0.3% to 8.7+/-0.4% in the standard feed group. No significant treatment*time effect was found for fasting glucose, insulin, (pre-) albumin or lipid profile, except for increase of HDL in the diabetes-specific group. CONCLUSIONS: The diabetes-specific feed studied significantly improved longer-term glycaemic control in diabetic patients. This was achieved in addition to on-going anti-diabetic medication and may affect clinical outcome.

Administration of a new diabetes-specific enteral formula results in an improved 24h glucose profile in type 2 diabetic patients.

AIMS: Study the effect of several boluses of a new diabetes-specific formula (DSF) during the day on 24h glucose profile. METHODS: In this randomized, controlled, double-blind, cross-over study 12 ambulatory type 2 diabetic patients were included. Subjects received a new DSF and an isocaloric standard fibre-containing formula (SF) while continuing their anti-diabetic medication. Subjects received 100% of their calculated daily energy requirements as bolus feeding every 3h (5 times/day, starting at 8.00 a.m.+/-1h). RESULTS: Glucose profiles were significantly better after administration of DSF compared with SF determined as mean glucose concentration (+/-SEM) (8.7+/-0.5 versus 9.6+/-0.6 mmol/L, p<0.05 during 24h; 9.4+/-0.6 versus 10.7+/-0.6 mmol/L, p<0.001 during daytime) or as incremental area under the curve during daytime (-44%; p<0.05). Subjects receiving DSF experienced less hyperglycaemic time over 24h (-26%; p<0.05) and during daytime (-30%; p<0.05). Furthermore, lower individual and mean (delta) peak glucose levels were found (p<0.05). No clinically relevant differences in gastrointestinal tolerance were observed. CONCLUSIONS: Using DSF resulted in significantly better 24h and postprandial glucose profiles than fibre-containing SF after bolus administration and may therefore help to improve glycaemic control in diabetic patients.

A specific blend of intact protein rich in aspartate has strong postprandial glucose attenuating properties in rats.

Three studies were carried out to help define an optimal protein blend for use in a nutritional product for diabetic patients. To this end, we tested the effects of coinfusions of combinations of different types of carbohydrates and proteins on the postprandial glycemic plasma response in healthy rats. Expt. 1 compared the effects of administering different forms of soy protein (intact protein, its hydrolysate, or an equivalent amount of the same amino acids), all in combination with a fixed amount of glucose (Glu), on postprandial Glu and insulin plasma concentrations. Intact soy protein (SI) had stronger insulinogenic properties compared with its hydrolysate but was equally potent in reducing the postprandial Glu response. In Expt. 2, we compared the effect of replacing 50% of the SI with the whey-derived protein alpha-lactalbumin when coingested with maltodextrin as the carbohydrate source. Only the specific aspartate-rich blend of SI and alpha-lactalbumin significantly improved the postprandial Glu response. In Expt. 3, we studied the effect of using the blend of SI and alpha-lactalbumin combined with a slowly digestible carbohydrate. The protein blend was still capable of significantly decreasing the postprandial Glu response even when a slow-release carbohydrate source was included. Combining this aspartate-rich protein blend with a slow-release carbohydrate might therefore lead to a low-glycemic nutritional product beneficial for dietary management in diabetic patients.

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients

Background: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. Methods: Forty patients participated in this randomised, controlled, double-blind, parallelgroup study. Subjects consumed 2 200 ml of diabetes-specific ONS (Diasip1) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. Results: Postprandial glucose responses (incremental area under curve) ( p < 0.01) and delta postprandial peak glucose concentration ( p < 0.01) were significantly lower in the diabetesspecific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose ( p = 0.074, t = 0 week vs. t = 12 weeks) and delta postprandial peak plasma glucose concentration ( p < 0.05, t = 0 week vs. t = 12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. Conclusions: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients.

BACKGROUND: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. METHODS: Forty patients participated in this randomised, controlled, double-blind, parallel-group study. Subjects consumed 2 x 200 ml of diabetes-specific ONS (Diasip) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. RESULTS: Postprandial glucose responses (incremental area under curve) (p<0.01) and delta postprandial peak glucose concentration (p<0.01) were significantly lower in the diabetes-specific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose (p=0.074, t=0 week vs. t=12 weeks) and delta postprandial peak plasma glucose concentration (p<0.05, t=0 week vs. t=12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. CONCLUSIONS: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.

Sterilization in a liquid of a specific starch makes it slowly digestible in vitro and low glycemic in rats.

Diabetics are recommended to eat a balanced diet containing normal amounts of carbohydrates, preferably those with a low glycemic index. For solid foods, this can be achieved by choosing whole-grain, fiber-rich products. For (sterilized) liquid products, such as meal replacers, the choices for carbohydrate sources are restricted due to technological limitations. Starches usually have a high glycemic index after sterilization in liquids, whereas low glycemic sugars and sugar replacers can only be used in limited amounts. Using an in vitro digestion assay, we identified a resistant starch (RS) source [modified high amylose starch (mHAS)] that might enable the production of a sterilized liquid product with a low glycemic index. Heating mHAS for 4-5 min in liquid increased the slowly digestible starch (SDS) fraction at the expense of the RS portion. The effect was temperature dependent and reached its maximum above 120 degrees C. Heating at 130 degrees C significantly reduced the RS fraction from 49 to 22%. The product remained stable for at least several months when stored at 4 degrees C. To investigate whether a higher SDS fraction would result in a lower postprandial glycemic response, the sterilized mHAS solution was compared with rapidly digestible maltodextrin. Male Wistar rats received an i.g. bolus of 2.0 g available carbohydrate/kg body weight. Ingestion of heat-treated mHAS resulted in a significant attenuation of the postprandial plasma glucose and insulin responses compared with maltodextrin. mHAS appears to be a starch source which, after sterilization in a liquid product, acquires slow-release properties. The long-term stability of mHAS solutions indicates that this may provide a suitable carbohydrate source for low glycemic index liquid products for inclusion in a diabetes-specific diet.