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Thomas S, Besecker B, Choe Y, Christofides E. Postprandial glycemic response to a high-protein diabetes-specific nutritional shake compared to isocaloric instant oatmeal in people with type 2 diabetes: a randomized, controlled, crossover trial. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1399410. [PMID: 38903056 PMCID: PMC11188454 DOI: 10.3389/fcdhc.2024.1399410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/30/2024] [Indexed: 06/22/2024]
Abstract
Introduction Minimizing postprandial glucose response is an important goal for overall diabetes management. Diabetes-specific nutritional shakes (DSNS) have been clinically shown to minimize postprandial glucose response in people with type 2 diabetes (T2DM) compared to high-glycemic foods. However, it is unknown how a high-protein, low-fat DSNS impacts the GLP-1 response. Methods We tested the postprandial glucose, insulin, and GLP-1 response to a high-protein, low-fat diabetes-specific nutritional shake (DSNS-HP) compared to isocaloric instant oatmeal (IOM) in a randomized, controlled, crossover study in adults with T2DM (n = 24). Participants were randomly selected to receive IOM or DSNS-HP on two test days. Glucose, insulin, and total GLP-1 concentration were measured at baseline and 15, 30, 45, 60, 90, 120, 180, and 240 min postprandially. Results Compared to IOM, the glucose-positive area under the curve (pAUC) was significantly lower (P = .021). DSNS-HP significantly increased GLP-1 pAUC response by 213% (P <.001) with a corresponding increase in insulin pAUC (P = .033) compared to IOM. Discussion A high-protein, low-fat DSNS leads to favorable changes in GLP-1 response and is a suitable option to minimize blood glucose response in people with type 2 diabetes.
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Affiliation(s)
- Sara Thomas
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Beth Besecker
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
| | - Yong Choe
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH, United States
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Mongkolsucharitkul P, Pinsawas B, Surawit A, Pongkunakorn T, Manosan T, Ophakas S, Suta S, Pumeiam S, Mayurasakorn K. Diabetes-Specific Complete Smoothie Formulas Improve Postprandial Glycemic Response in Obese Type 2 Diabetic Individuals: A Randomized Crossover Trial. Nutrients 2024; 16:395. [PMID: 38337679 PMCID: PMC10857113 DOI: 10.3390/nu16030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare newly developed diabetes-specific complete smoothie formulas with a standard diabetes-specific nutritional formula (DSNF) regarding their effects on glucose homeostasis, insulin levels, and lipid metabolism in obese type 2 diabetes (T2DM) patients. We conducted a randomized, double-blind, crossover study with 41 obese T2DM participants to compare two developed diabetes-specific complete smoothie formulas, a soy-based regular smoothie (SM) and a smoothie with modified carbohydrate content (SMMC), with the standard DSNF, Glucerna. Glycemic and insulin responses were assessed after the participants randomly consumed 300 kilocalories of each formulation on three separate days with a 7-day gap between. Postprandial effects on glycemic control, insulin levels, and lipid metabolism were measured. SMMC resulted in a significantly lower glucose area under the curve (AUC0-240) compared to Glucerna and SM (p < 0.05 for both). Insulin AUC0-240 after SMMC was significantly lower than that after SM and Glucerna (p < 0.05). During the diets, the suppression of NEFA was more augmented on SM, resulting in a less total AUC0-240 of NEFA compared to the SMMC diet (p < 0.05). C-peptide AUC0-240 after SMMC was significantly lower than that after Glucerna (p < 0.001). Conversely, glucagon AUC0-240 after SMMC was significantly higher than that after SM and Glucerna (p < 0.05). These results highlight SMMC as the better insulin-sensitive formula, potentially achieved through increased insulin secretion or a direct reduction in glucose absorption. The unique composition of carbohydrates, amino acids, and fats from natural ingredients in the smoothies may contribute to these positive effects, making them promising functional foods for managing diabetes and obesity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Korapat Mayurasakorn
- Siriraj Population Health and Nutrition Research Group, Department of Research Group and Research Network, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.M.); (B.P.); (A.S.); (T.P.); (T.M.); (S.O.); (S.S.); (S.P.)
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Vegas Aguilar IM, Porca Fernández C, Casañas Quintana T, Calleja Fernández A, Tejera Pérez C, Tinahones Madueño FJ, Bellido Guerrero D, García Almeida JM. [Organoleptic evaluation of a diabetes-specific oral nutritional supplement with extra virgin olive oil in patients at nutritional risk and type 2 diabetes mellitus: Double-blind, randomized, crossover and multicenter clinical trial (DIACARE)]. NUTR HOSP 2023; 40:686-691. [PMID: 37409710 DOI: 10.20960/nh.04569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction Introduction: oral nutritional supplements specific for diabetes (DSF) usually have a composition that favors their palatability and simultaneous glycemic and metabolic control. Objetive: to compare the sensory acceptability of a DSF with respect to a standard oral nutritional supplement (STF) in patients at risk of malnutrition with type 2 diabetes mellitus. Method: randomized, double-blind, crossover, multicenter, controlled, double-blind clinical trial. Odor, taste and perceived texture of a DSF and a STD were evaluated using a scale of 1 to 4. Results: twenty-nine patients were recruited and 58 organoleptic evaluations of the supplements were registered. A better evaluation of DSF was observed with respect to STD, although no statistically significant differences were reached: odor, 0.04 (CI 95 %) -0.49 to 0.56 (p = 0.092); taste, 0.14 (CI 95 %), -0.35 to 0.63 (p = 0.561); texture, 0.14 (CI 95 %), -0.43 to 0.72 (p = 0.619). No differences were found when analyzed by order of randomization, sex, degree of malnutrition, greater or lesser degree of complexity, greater or lesser time of evolution of diabetes, or by being older or younger. Conclusions: the specific nutritional supplement for diabetic patients formulated with extra virgin olive oil, EPA and DHA, a specific mixture of carbohydrates, and fiber, presented an adequate sensory acceptance by malnourished patients with type 2 diabetes mellitus.
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Affiliation(s)
| | | | | | | | - Cristina Tejera Pérez
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Ferrol
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García Almeida JM, Vegas Aguilar IM, Calleja Fernández A, Porca Fernández C, Casañas Quintana T, Tejera Pérez C, Tinahones Madueño FJ, Bellido Guerrero D. Glycaemic and insulinaemic impact of a diabetes-specific oral nutritional supplement with extra-virgin olive oil in patients with type 2 diabetes mellitus at nutritional risk: a randomized, double-blind, crossover, multicentre clinical trial (DIACARE). NUTR HOSP 2023; 40:692-700. [PMID: 37409714 DOI: 10.20960/nh.04577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction Introduction: there is controversy about the usefulness of specific enteral nutrition formulas in malnourished patients with diabetes. The effects on blood glucose and other aspects of metabolic control are not fully understood in the scientific literature. Objective: the aim of the study was to compare the glycaemic and insulinaemic response of patients with type 2 diabetes at risk of malnutrition after oral feed between a diabetes-specific formula with AOVE (DSF) and a standard one (STF). Methods: A randomized, double-blind, crossover, multicentre clinical trial was conducted in patients with type 2 diabetes at risk of malnutrition (SGA). The patients were randomized to receive either DSF or STF, a week apart. A glycaemia and insulinaemia curve was made at times 0 minutes, 30 min, 60 min, 90 min, 120 min, and 180 min after the patients drank 200 ml of the oral nutritional supplement (ONS). The principal variables were the area under the curve (AUC0-t) of glucose and insulin. Results: 29 patients (51 % women) were included, who were on average 68.84 (SD 11.37) years old. Regarding the degree of malnutrition, 86.2 % presented moderate malnutrition (B) and 13.8 % severe (C). When the patients received the DSF, they had a lower mean of glucose AUC0-t (-3,325.34 mg/min/dl [95 % CI: -4,3608.34 to -2,290.07]; p = 0.016) and also a lower mean of insulin AUC0-t (-451.14 uU/min/ml [95 % CI: -875,10 to -27.17]; p = 0.038). There were no differences in the degree of malnutrition. Conclusion: compared with STF, DSF with AOVE showed a better glycaemic and insulinaemic response in patients with type 2 diabetes at risk of malnutrition.
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Affiliation(s)
| | | | | | | | | | - Cristina Tejera Pérez
- Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Ferrol
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Chaiyakul S, Ketkham N, Chaichana C, Khumkhana N, Deekum W, Wongshaya P, Suwanmalai T, Hutchinson C, Pramyothin P. Effects of a novel rice-based diabetes-specific formula on postprandial glucose and gastrointestinal hormones: a double-blinded multi-arm randomized crossover trial. Front Endocrinol (Lausanne) 2023; 14:1141497. [PMID: 37293492 PMCID: PMC10244629 DOI: 10.3389/fendo.2023.1141497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction We developed a novel rice-based medical food for diabetes (MFDM) powder formula, using locally available ingredients in Thailand, which can potentially improve patient access to diabetes-specific formula (DSF) by reducing cost and improving availability. Purpose The goals of our studies were to 1) measure the glycemic index (GI) and glycemic load (GL) of the MFDM powder formula in healthy individuals, and 2) assess postprandial glucose, insulin, satiety, hunger, and gastrointestinal (GI) hormone responses in adults with prediabetes or early type 2 diabetes after consuming MFDM in comparison with a commercially available standard formula (SF) and a DSF. Methods In Study 1, glycemic responses were assessed using the area under the curve (AUC), which was used to calculate GI and GL. Study 2 was a double-blinded multi-arm randomized crossover trial enrolling participants with either prediabetes or type 2 diabetes of ≤6 years. At each study visit, participants consumed either MFDM, SF, or DSF which contained 25 g of carbohydrates. Hunger and satiety were assessed using a visual analog scale (VAS). Glucose, insulin, and GI hormones were assessed using AUC. Results All participants tolerated the MFDM well with no adverse events. In Study 1, the measured GI was 39 ± 6 (low GI) and GL was 11 ± 2 (medium GL). In Study 2, glucose and insulin responses were significantly lower after MFDM compared with SF (p-value<0.01 for both), however, those responses were similar between MFDM and DSF. MFDM suppressed hunger, promoted satiety, stimulated active GLP-1, GIP, and PYY, and suppressed active ghrelin although these changes were similar to SF and DSF. Conclusions MFDM had a low GI and a low-to-medium GL. In people with prediabetes or early type 2 diabetes, MFDM elicited reduced glucose and insulin responses when compared with SF. Rice-based MFDM may be an option for patients who are at risk for postprandial hyperglycemia. Clinical Trial Registration https://www.thaiclinicaltrials.org/show/TCTR20210731001, identifier TCTR20210731001; https://www.thaiclinicaltrials.org/show/TCTR20210730007, identifier TCTR20210730007.
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Affiliation(s)
- Supat Chaiyakul
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Narong Ketkham
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chartchai Chaichana
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nanta Khumkhana
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanjan Deekum
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakwuan Wongshaya
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thaniya Suwanmalai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carol Hutchinson
- Department of Nutrition, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Pornpoj Pramyothin
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lin XQ, Chen YR, Chen X, Cai YP, Lin JX, Xu DM, Zheng XC. Impact of preoperative carbohydrate loading on gastric volume in patients with type 2 diabetes. World J Clin Cases 2022; 10:6082-6090. [PMID: 35949825 PMCID: PMC9254193 DOI: 10.12998/wjcc.v10.i18.6082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery advocates that consuming carbohydrates two hours before anesthesia is beneficial to the patient's recovery. Patients with diabetes are prone to delayed gastric emptying. Different guidelines for preoperative carbohydrate consumption in patients with diabetes remain controversial due to concerns about the risk of regurgitation, aspiration and hyperglycemia. Ultrasonic gastric volume (GV) assessment and blood glucose monitoring can comprehensively evaluate the safety and feasibility of preoperative carbohydrate intake in type 2 diabetes (T2D) patients.
AIM To evaluate the impact of preoperative carbohydrate loading on GV before anesthesia induction in T2D patients.
METHODS Patients with T2D receiving surgery under general anesthesia from December 2019 to December 2020 were included. A total of 78 patients were randomly allocated to 4 groups receiving 0, 100, 200, or 300 mL of carbohydrate loading 2 h before anesthesia induction. Gastric volume per unit weight (GV/W), Perlas grade, changes in blood glucose level, and risk of reflux and aspiration were evaluated before anesthesia induction.
RESULTS No significant difference was found in GV/W among the groups before anesthesia induction (P > 0.05). The number of patients with Perlas grade II and GV/W > 1.5 mL/kg did not differ among the groups (P > 0.05). Blood glucose level increased by > 2 mmol/L in patients receiving 300 mL carbohydrate drink, which was significantly higher than that in groups 1 and 2 (P < 0.05).
CONCLUSION Preoperative carbohydrate loading < 300 mL 2 h before induction of anesthesia in patients with T2D did not affect GV or increase the risk of reflux and aspiration. Blood glucose levels did not change significantly with preoperative carbohydrate loading of < 200 mL. However, 300 mL carbohydrate loading may increase blood glucose levels in patients with T2D before induction of anesthesia.
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Affiliation(s)
- Xin-Qiang Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian Maternity and Child Care Hospital, Putian 351100, Fujian Province, China
| | - Yu-Ren Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Yu-Ping Cai
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Jian-Xin Lin
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - De-Ming Xu
- Department of Anesthesiology, Affiliated Hospital of Putian College, Putian 351100, Fujian Province, China
| | - Xiao-Chun Zheng
- Department of Anesthesiology, Shenli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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Jiménez-Sánchez A, Martínez-Ortega AJ, Remón-Ruiz PJ, Piñar-Gutiérrez A, Pereira-Cunill JL, García-Luna PP. Therapeutic Properties and Use of Extra Virgin Olive Oil in Clinical Nutrition: A Narrative Review and Literature Update. Nutrients 2022; 14:nu14071440. [PMID: 35406067 PMCID: PMC9003415 DOI: 10.3390/nu14071440] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
Extra virgin olive oil (EVOO) is a cornerstone of the Mediterranean diet (MedD). In this narrative review, we synthesize and illustrate the various characteristics and clinical applications of EVOO and its components—such as oleic acid, hydroxytyrosol, and oleuropein—in the field of clinical nutrition and dietetics. The evidence is split into diet therapy, oleic acid-based enteral nutrition formulations and oral supplementation formulations, oleic acid-based parenteral nutrition, and nutraceutical supplementation of minor components of EVOO. EVOO has diverse beneficial health properties, and current evidence supports the use of whole EVOO in diet therapy and the supplementation of its minor components to improve cardiovascular health, lipoprotein metabolism, and diabetes mellitus in clinical nutrition. Nevertheless, more intervention studies in humans are needed to chisel specific recommendations for its therapeutic use through different formulations in other specific diseases and clinical populations.
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Affiliation(s)
- Andrés Jiménez-Sánchez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Correspondence: (A.J.-S.); (P.P.G.-L.)
| | - Antonio Jesús Martínez-Ortega
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Torrecárdenas, C. Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Pablo Jesús Remón-Ruiz
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - Ana Piñar-Gutiérrez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - José Luis Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
| | - Pedro Pablo García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Seville, Spain; (P.J.R.-R.); (A.P.-G.); (J.L.P.-C.)
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Avda. Manuel Siurot s/n, 41013 Seville, Spain;
- Correspondence: (A.J.-S.); (P.P.G.-L.)
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Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis. Clin Nutr 2020; 39:3273-3282. [DOI: 10.1016/j.clnu.2020.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
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Patel VN, Dijk G, Malarkey B, Brooke JR, Whelan K, MacLaughlin HL. Glycemic Response to a Renal-Specific Oral Nutritional Supplement in Patients With Diabetes Undergoing Hemodialysis: A Randomized Crossover Trial. JPEN J Parenter Enteral Nutr 2020; 45:267-276. [PMID: 32713006 DOI: 10.1002/jpen.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes and malnutrition are common in patients with kidney failure. We aimed to evaluate the postprandial glucose response to oral nutritional supplement drinks (ONSs) in patients with diabetes undergoing hemodialysis treatment. METHODS A randomized, single-blind crossover study was conducted in patients with diabetes, and requiring chronic hemodialysis. Patients consumed either a renal-specific ONS, macronutrient-matched ONS, or standard ONS on 3 separate study days, during dialysis, following an overnight fast. Blood was collected before and 15, 30, 45, 60, 90, 120, and 180 minutes post ingestion. Mean net incremental area under the curve (iAUC) and peak incremental blood glucose concentration were compared across conditions, using analyses of variance. RESULTS Consumption of the renal-specific ONS resulted in the lowest mean net iAUC (87.9 ± 169.0 mmol/L per 3 hours) compared with macronutrient-matched (188.0 ± 127.5 mmol/L per 3 hours) and standard ONS (199.5 ± 169.2 mmol/L per 3 hours) (F2,30 = 5.115, P = 0.012, partial n2 = 0.254). Pairwise comparisons demonstrated a mean difference of 100.1 mmol/L per 3 hours (95% CI, -2.8 to 202.9) in mean iAUC between the renal-specific ONS and macronutrient-matched ONS (P = 0.058). Peak blood glucose concentration, corrected for baseline, was significantly lower after the renal-specific ONS (1.40 ± 1.0 mmol/L) compared with both macronutrient-matched (2.02 ± 0.71 mmol/L, P = 0.036) and standard ONS (2.3 ± 1.06 mmol/L, P = 0.017). CONCLUSION A renal-specific ONS elicits a lower postprandial glucose response than either macronutrient-matched ONS or standard ONS in patients with diabetes during hemodialysis.
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Affiliation(s)
| | - Giulia Dijk
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK
| | - Bridget Malarkey
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jennifer R Brooke
- Department of Nutritional Sciences, King's College London, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Helen L MacLaughlin
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK.,Queensland University of Technology (QUT) School of Exercise and Nutrition Sciences, Brisbane, Australia
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Mustad VA, Hegazi RA, Hustead DS, Budiman ES, Rueda R, Maki K, Powers M, Mechanick JI, Bergenstal RM, Hamdy O. Use of a diabetes-specific nutritional shake to replace a daily breakfast and afternoon snack improves glycemic responses assessed by continuous glucose monitoring in people with type 2 diabetes: a randomized clinical pilot study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001258. [PMID: 32718934 PMCID: PMC7389484 DOI: 10.1136/bmjdrc-2020-001258] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION This pilot study evaluated the impact of a diabetes-specific nutritional shake (DSNS) used twice daily by people with type 2 diabetes (T2D) on glycemic response assessed by continuous glucose monitoring (CGM). RESEARCH DESIGN AND METHODS Adults (n=81) with T2D managed by oral medications were studied in a randomized, open-label, three-group parallel study design. The study was conducted in two phases over 14 days: Baseline (days 1-6), during which study participants consumed their habitual self-selected diets (SSD), followed by the Intervention (days 7-14), during which participants were randomized as follows: (1) SSD group received no study product (n=32); (2) DSNS breakfast/afternoon snack (Bkfst/AS) group consumed one DSNS as a breakfast meal replacement and a second to replace their mid-afternoon snack (n=24); (3) DSNS breakfast/prebed snack (Bkfst/PBS) group consumed one DSNS as a breakfast meal replacement and added a second as a prebed snack (n=25). Glucose was assessed by CGM throughout the study. Additionally, participants were asked about snacking behaviors, cravings, and other questions related to the use of DSNS as meal replacements and snacks. RESULTS All groups reduced their postprandial glycemic response (positive area under the curve (pAUC, mg/min*dL-1)) and adjusted peak value (mg/dL) when compared with the baseline phase. Participants consuming DSNS in place of their usual breakfast showed greater reductions in pAUC compared with the SSD group (p=0.008) for the DSNS Bkfst/AS group with a trend (p=0.069) for the DSNS Bkfst/PBS group. Adjusted peak value showed greater reductions in both DSNS groups as compared with the SSD group (p=0.002 for DSNS Bkfst/AS and p=0.010 for DSNS Bkfst/PBS). Nocturnal glucose variability was significantly decreased during the intervention phase compared with baseline phase in the DSNS Bkfst/AS group (p=0.020), with no significant differences between groups. After intervention, the DSNS Bkfst/AS group had a significantly lower percentage of participants (17%) reporting cravings for starchy meals/sides compared with before the study (33%) (p=0.046). This group also reported a significant increase in confidence in choosing foods to control their diabetes (from 58.3% to 91.7%, preintervention vs postintervention, respectively, p=0.005). CONCLUSIONS Use of DSNS to replace breakfast and as an afternoon snack improves both glycemic control and behavioral factors related to dietary management of diabetes. TRAIL REGISTRATION NUMBER NCT04230889.
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Affiliation(s)
- Vikkie A Mustad
- Research and Development Department, Abbott Nutrition, Columbus, Ohio, USA
| | - Refaat A Hegazi
- Research and Development Department, Abbott Nutrition, Columbus, Ohio, USA
- Adjunct Associate Professor, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Deborah S Hustead
- Research and Development Department, Abbott Nutrition, Columbus, Ohio, USA
| | - Erwin S Budiman
- Research and Development Department, Abbott Diabetes Care, Alameda, California, USA
| | - Ricardo Rueda
- Research and Development Department, Abbott Nutrition, Granada, Spain
| | - Kevin Maki
- President and Chief Scientist, MB Clinical Research, Boca Raton, Florida, USA
- Indiana University School of Public Health, Bloomington, Indiana, USA
| | - Margaret Powers
- International Diabetes Center at Park Nicollet, St. Louis Park, Minnesota, USA
| | - Jeffrey I Mechanick
- Professor of Medicine and Medical Director, Kravis Center for Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Osama Hamdy
- Obesity Clinical Program, Director of Inpatient Diabetes Program, Joslin Diabetes Center, Boston, Massachusetts, USA
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11
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The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients 2020; 12:nu12020385. [PMID: 32024026 PMCID: PMC7071246 DOI: 10.3390/nu12020385] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Gestational diabetes (GDM) is hyperglycemia that is recognized for the first time during pregnancy. GDM is associated with a wide range of short- and long-term adverse health consequences for both mother and offspring. It is a complex disease with a multifactorial etiology, with disturbances in glucose, lipid, inflammation and gut microbiota. Consequently, its management is complex, requiring patients to self-manage their diet, lifestyle and self-care behaviors in combination with use of insulin. In addition to nutritional recommendations for all pregnant women, special attention to dietary carbohydrate (CHO) amount and type on glucose levels is especially important in GDM. Dietary CHO are diverse, ranging from simple sugars to longer-chain oligo- and poly- saccharides which have diverse effects on blood glucose, microbial fermentation and bowel function. Studies have established that dietary CHO amount and type can impact maternal glucose and nutritional recommendations advise women with GDM to limit total intake or choose complex and low glycemic CHO. However, robust maternal and infant benefits are not consistently shown. Novel approaches which help women with GDM adhere to dietary recommendations such as diabetes-specific meal replacements (which provide a defined and complete nutritional composition with slowly-digested CHO) and continuous glucose monitors (which provide unlimited monitoring of maternal glycemic fluctuations) have shown benefits on both maternal and neonatal outcomes. Continued research is needed to understand and develop tools to facilitate patient adherence to treatment goals, individualize interventions and improve outcomes.
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12
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The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2019; 11:nu11081905. [PMID: 31443185 PMCID: PMC6722646 DOI: 10.3390/nu11081905] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The prevalence of diabetes is on the increase in the UK and worldwide, partly due to unhealthy lifestyles, including poor dietary regimes. Patients with diabetes and other co-morbidities such as stroke, which may affect swallowing ability and lead to malnutrition, could benefit from enteral nutrition, including the standard formula (SF) and diabetes-specific formulas (DSF). However, enteral nutrition presents its challenges due to its effect on glycaemic control and lipid profile. AIM The aim of this review was to evaluate the effectiveness of diabetes-specific enteral nutrition formula versus SF in managing cardiometabolic parameters in patients with type 2 diabetes. METHOD This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses. Three databases (Pubmed, EMBASE, PSYCInfo) and Google scholar were searched for relevant articles from inception to 2 January 2019 based on Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. Key words, Medical Subject Heading (MeSH) terms, and Boolean operators (AND/OR) formed part of the search strategy. Articles were evaluated for quality and risks of bias. RESULTS Fourteen articles were included in the systematic review and five articles were selected for the meta-analysis. Based on the findings of the review and meta-analysis, two distinct areas were evident: the effect of DSF on blood glucose parameters and the effect of DSF on lipid profile. All fourteen studies included in the systematic review showed that DSF was effective in lowering blood glucose parameters in patients with type 2 diabetes compared with SF. The results of the meta-analysis confirmed the findings of the systematic review with respect to the fasting blood glucose, which was significantly lower (p = 0.01) in the DSF group compared to SF, with a mean difference of -1.15 (95% CI -2.07, -0.23) and glycated haemoglobin, which was significantly lower (p = 0.005) in the DSF group compared to the SF group following meta-analysis and sensitivity analysis. However, in relation to the sensitivity analysis for the fasting blood glucose, differences were not significant between the two groups when some of the studies were removed. Based on the systematic review, the outcomes of the studies selected to evaluate the effect of DSF on lipid profile were variable. Following the meta-analysis, no significant differences (p > 0.05) were found between the DSF and SF groups with respect to total cholesterol, LDL cholesterol and triglyceride. The level of the HDL cholesterol was significantly higher (p = 0.04) in the DSF group compared to the SF group after the intervention, with a mean difference of 0.09 (95% CI, 0.00, 0.18), although this was not consistent based on the sensitivity analysis. The presence of low glycaemic index (GI) carbohydrate, the lower amount of carbohydrate and the higher protein, the presence of mono-unsaturated fatty acids and the different amounts and types of fibre in the DSF compared with SF may be responsible for the observed differences in cardiometabolic parameters in both groups. CONCLUSION The results provide evidence to suggest that DSF is effective in controlling fasting blood glucose and glycated haemoglobin and in increasing HDL cholesterol, but has no significant effect on other lipid parameters. However, our confidence in these findings would be increased by additional data from further studies.
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Angarita Dávila L, Bermúdez V, Aparicio D, Céspedes V, Escobar MC, Durán-Agüero S, Cisternas S, de Assis Costa J, Rojas-Gómez D, Reyna N, López-Miranda J. Effect of Oral Nutritional Supplements with Sucromalt and Isomaltulose versus Standard Formula on Glycaemic Index, Entero-Insular Axis Peptides and Subjective Appetite in Patients with Type 2 Diabetes: A Randomised Cross-Over Study. Nutrients 2019; 11:E1477. [PMID: 31261732 PMCID: PMC6683048 DOI: 10.3390/nu11071477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 12/25/2022] Open
Abstract
Oral diabetes-specific nutritional supplements (ONS-D) induce favourable postprandial responses in subjects with type 2 diabetes (DM2), but they have not been correlated yet with incretin release and subjective appetite (SA). This randomised, double-blind, cross-over study compared postprandial effects of ONS-D with isomaltulose and sucromalt versus standard formula (ET) on glycaemic index (GI), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and SA in 16 individuals with DM2. After overnight fasting, subjects consumed a portion of supplements containing 25 g of carbohydrates or reference food. Blood samples were collected at baseline and at 30, 60, 90, 120, 150 and 180 min; and SA sensations were assessed by a visual analogue scale on separate days. Glycaemic index values were low for ONS-D and intermediate for ET (p < 0.001). The insulin area under the curve (AUC0-180 min) (p < 0.02) and GIP AUC (p < 0.02) were lower after ONS-D and higher GLP-1 AUC when compared with ET (p < 0.05). Subjective appetite AUC was greater after ET than ONS-D (p < 0.05). Interactions between hormones, hunger, fullness and GI were found, but not within the ratings of SA; isomaltulose and sucromalt may have influenced these factors.
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Affiliation(s)
- Lisse Angarita Dávila
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Sede Concepción 4260000, Chile.
| | - Valmore Bermúdez
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla 080003, Colombia
| | - Daniel Aparicio
- Centro de Investigaciones Endocrino-Metabólicas "Dr. Félix Gómez", Escuela de Medicina. Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela
| | - Virginia Céspedes
- Departamento de Medicina Física y Rehabilitación, Hospital "12 de Octubre", Madrid 28041, Spain
| | - Ma Cristina Escobar
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Sede Concepción 4260000, Chile
| | - Samuel Durán-Agüero
- Escuela de Nutrición y Dietética, Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Santiago 7500000, Chile
| | - Silvana Cisternas
- Escuela de Salud, Universidad Tecnológica de Chile, INACAP, Sede Concepción, Talcahuano 4260000, Chile
| | - Jorge de Assis Costa
- Faculty of Medicine/UniFAGOC, Ubá 36506-022, Minas Gerais, Brazil
- Universidade do Estado de Minas Gerais (UEMG), Barbacena 36202-284, Minas Gerais, Brazil
| | - Diana Rojas-Gómez
- Escuela de Nutrición y Dietética, Facultad de Medicina, Universidad Andres Bello, Santiago 8370321, Chile
| | - Nadia Reyna
- Centro de Investigaciones Endocrino-Metabólicas "Dr. Félix Gómez", Escuela de Medicina. Facultad de Medicina, Universidad del Zulia, Maracaibo 4001, Venezuela
| | - Jose López-Miranda
- Lipids and Atherosclerosis Unit, Maimonides Institute for Biomedical Research in Cordoba, Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
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14
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Matia Martin P, Robles Agudo F, Lopez Medina JA, Sanz Paris A, Tarazona Santabalbina F, Domenech Pascual JR, Lopez Penabad L, Sanz Barriuso R. Effectiveness of an oral diabetes-specific supplement on nutritional status, metabolic control, quality or life, and functional status in elderly patients. A multicentre study. Clin Nutr 2019; 38:1253-1261. [DOI: 10.1016/j.clnu.2018.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/13/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022]
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15
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Mehta Y, Mithal A, Kulkarni A, Reddy BR, Sharma J, Dixit S, Zirpe K, Sivakumar MN, Bathina H, Chakravarti S, Joshi A, Rao S. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2019; 23:594-603. [PMID: 31988554 PMCID: PMC6970214 DOI: 10.5005/jp-journals-10071-23298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and aim Intensive-care practices and settings differ for India in comparison to other countries. While guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to nutritional management of EN in dysglycemic patients, specific to patients in Indian critical care settings. Advisory board meetings were arranged to develop the practice guidelines specific to the Indian context, for the use of EN in dysglycemic critically ill patients and to overcome challenges in this field. Materials and methods Two advisory board meetings were organized to review various existing guidelines, meta-analyses, randomized controlled trials (RCTs), controlled trials and review articles, for their contextual relevance and strength. Three rounds of Delphi voting were done to arrive at consensus on certain recommendations. A systematic grading of practice guidelines by the advisory board was done based on strength of the consensus voting and reviewed supporting evidences. Results Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding prediction and assessment of dysglycemia (DG), acceptable glycemic targets in such settings, general nutritional aspects pertaining to DG nutrition, and nutrition in various superspecialty cases in critical care settings, where DG is commonly encountered. Conclusion This paper summarizes the optimum EN practices for managing DG in critically ill patients. The practical solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance for EN management in dysglycemic critically ill patients. These guidelines also outline the model glycemic control task force and its roles in nutrition care as well as an intensive care unit DG nutrition protocol. How to cite this article Mehta Y, Mithal A, Kulkarni A, Reddy BR, Sharma J, Dixit S, et al. Practice Guidelines for Enteral Nutrition Management in Dysglycemic Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2019;23(12):594–603.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Ambrish Mithal
- Department of Endocrinology and Diabetology, Institute of Endocrinology and Diabetology, Medanta: The Medicity, Gurugram, Haryana, India
| | - Atul Kulkarni
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - B Ravinder Reddy
- Department of Gastrointestinal Surgery, The Institute of Medical Sciences, Care Hospitals, Hyderabad, Telangana, India
| | - Jeetendra Sharma
- Department of Critical Care Medicine, Artemis Hospital, Gurugram, Haryana, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Kapil Zirpe
- Department of Intensive Care and Neurotrauma-Stroke Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - M N Sivakumar
- Department of Critical Care Medicine, Royal Care Super Specialty Hospital, Coimbatore, Tamil Nadu, India
| | - Harita Bathina
- Department of Dietetics, Apollo Hospitals, Hyderabad, Telangana, India
| | - Sanghamitra Chakravarti
- Department of Nutrition and Dietetics, Medica Superspecialty Hospital, Kolkata, West Bengal, India
| | - Anshu Joshi
- Department of Scientific and Medical Affairs, Abbott Nutrition International, India
| | - Sameer Rao
- Department of Scientific and Medical Affairs, Abbott Nutrition International, India
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Hetrick MM, Naquin MR, Gillan WW, Williams BM, Kraemer RR. A Hydrothermally Processed Maize Starch and Its Effects on Blood Glucose Levels During High-Intensity Interval Exercise. J Strength Cond Res 2018; 32:3-12. [DOI: 10.1519/jsc.0000000000001856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Shao Y, Heng W, Li S, Xu Y, Hu G. Tube Feeding with a Diabetes-Specific Enteral Formula Improves Glycemic Control in Severe Acute Ischemic Stroke Patients. JPEN J Parenter Enteral Nutr 2017; 42:926-932. [PMID: 30001465 DOI: 10.1002/jpen.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Glycemic control is essential for managing acute stroke. This study evaluated the impact of a diabetes-specific formula (DSF) on glycemic control in severe acute ischemic stroke patients. METHODS A randomized, prospective controlled trial was conducted in Nanjing Drum Tower Hospital. Acute ischemic stroke patients who scored > 10 on the National Institutes of Health Stroke Scale as well as had swallowing problems were randomized to group A, which received a diabetes-specific enteral formula, and group B, which received a standard formula. Glycemic parameters were assessed at baseline and 7 days after admission. RESULTS One hundred four patients were enrolled in the study (group A, 53; group B, 51). Postprandial glucose parameters, including capillary glucose concentration from 8 hours to 16 hours after enteral nutrition (EN) consumption, incremental areas under the curve (iAUC0-16 h ), peak value, and mean glucose concentration, were significantly lower in group A than in group B following a 7-day intervention period. Moreover, changes in HOMAIR after the 7-day treatment were significantly higher in group A than in group B. No significant difference in the incidence of hypoglycemia, glycemic variability parameters, or nutrition parameters was found between the 2 groups, either at baseline or after treatment. There were no serious adverse events observed during the study. CONCLUSION A diabetes-specific formula may improve acute-term glycemic control in severe acute ischemic stroke patients.
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Affiliation(s)
- Yuan Shao
- Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.,Department of Neurology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, PR China
| | - Weiwei Heng
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, Jiangsu, PR China
| | - Shanshan Li
- Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.,Department of Neurology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu, PR China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Gang Hu
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, Jiangsu, PR China.,Department of Pharmacology, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, PR China
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18
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Mottalib A, Mohd-Yusof BN, Shehabeldin M, Pober DM, Mitri J, Hamdy O. Impact of Diabetes-Specific Nutritional Formulas versus Oatmeal on Postprandial Glucose, Insulin, GLP-1 and Postprandial Lipidemia. Nutrients 2016; 8:nu8070443. [PMID: 27455318 PMCID: PMC4963919 DOI: 10.3390/nu8070443] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/24/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
Diabetes-specific nutritional formulas (DSNFs) are frequently used as part of medical nutrition therapy for patients with diabetes. This study aims to evaluate postprandial (PP) effects of 2 DSNFs; Glucerna (GL) and Ultra Glucose Control (UGC) versus oatmeal (OM) on glucose, insulin, glucagon-like peptide-1 (GLP-1), free fatty acids (FFA) and triglycerides (TG). After an overnight fast, 22 overweight/obese patients with type 2 diabetes were given 200 kcal of each of the three meals on three separate days in random order. Blood samples were collected at baseline and at 30, 60, 90, 120, 180 and 240 min. Glucose area under the curve (AUC0–240) after GL and UGC was lower than OM (p < 0.001 for both). Insulin positive AUC0–120 after UGC was higher than after OM (p = 0.02). GLP-1 AUC0–120 and AUC0–240 after GL and UGC was higher than after OM (p < 0.001 for both). FFA and TG levels were not different between meals. Intake of DSNFs improves PP glucose for 4 h in comparison to oatmeal of similar caloric level. This is achieved by either direct stimulation of insulin secretion or indirectly by stimulating GLP-1 secretion. The difference between their effects is probably related to their unique blends of amino acids, carbohydrates and fat.
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Affiliation(s)
| | - Barakatun-Nisak Mohd-Yusof
- Joslin Diabetes Center, Boston, MA 02215, USA.
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor 43400, Malaysia.
| | | | | | | | - Osama Hamdy
- Joslin Diabetes Center, Boston, MA 02215, USA.
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Mesejo A, Montejo-González JC, Vaquerizo-Alonso C, Lobo-Tamer G, Zabarte-Martinez M, Herrero-Meseguer JI, Acosta-Escribano J, Blesa-Malpica A, Martinez-Lozano F. Diabetes-specific enteral nutrition formula in hyperglycemic, mechanically ventilated, critically ill patients: a prospective, open-label, blind-randomized, multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:390. [PMID: 26549276 PMCID: PMC4638090 DOI: 10.1186/s13054-015-1108-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/19/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Although standard enteral nutrition is universally accepted, the use of disease-specific formulas for hyperglycemic patients is still controversial. This study examines whether a high-protein diabetes-specific formula reduces insulin needs, improves glycemic control and reduces ICU-acquired infection in critically ill, hyperglycemic patients on mechanical ventilation (MV). METHODS This was a prospective, open-label, randomized (web-based, blinded) study conducted at nine Spanish ICUs. The patient groups established according to the high-protein formula received were: group A, new-generation diabetes-specific formula; group B, standard control formula; group C, control diabetes-specific formula. Inclusion criteria were: expected enteral nutrition ≥5 days, MV, baseline glucose >126 mg/dL on admission or >200 mg/dL in the first 48 h. Exclusion criteria were: APACHE II ≤10, insulin-dependent diabetes, renal or hepatic failure, treatment with corticosteroids, immunosuppressants or lipid-lowering drugs and body mass index ≥40 kg/m(2). The targeted glucose level was 110-150 mg/dL. Glycemic variability was calculated as the standard deviation, glycemic lability index and coefficient of variation. Acquired infections were recorded using published consensus criteria for critically ill patients. Data analysis was on an intention-to-treat basis. RESULTS Over a 2-year period, 157 patients were consecutively enrolled (A 52, B 53 and C 52). Compared with the standard control formula, the new formula gave rise to lower insulin requirement (19.1 ± 13.1 vs. 23.7 ± 40.1 IU/day, p <0.05), plasma glucose (138.6 ± 39.1 vs. 146.1 ± 49.9 mg/dL, p <0.01) and capillary blood glucose (146.1 ± 45.8 vs. 155.3 ± 63.6 mg/dL, p <0.001). Compared with the control diabetes-specific formula, only capillary glucose levels were significantly reduced (146.1 ± 45.8 vs. 150.1 ± 41.9, p <0.01). Both specific formulas reduced capillary glucose on ICU day 1 (p <0.01), glucose variability in the first week (p <0.05), and incidences of ventilator-associated tracheobronchitis (p <0.01) or pneumonia (p <0.05) compared with the standard formula. No effects of the nutrition formula were produced on hospital stay or mortality. CONCLUSIONS In these high-risk ICU patients, both diabetes-specific formulas lowered insulin requirements, improved glycemic control and reduced the risk of acquired infections relative to the standard formula. Compared with the control-specific formula, the new-generation formula also improved capillary glycemia. TRIAL REGISTRATION Clinicaltrials.gov NCT1233726 .
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Affiliation(s)
- Alfonso Mesejo
- Intensive Care Unit, Hospital Clínico Universitario, Avda Blasco Ibáñez 17, 46010, Valencia, Spain.
| | | | - Clara Vaquerizo-Alonso
- Intensive Care Unit, Hospital Universitario de Fuenlabrada, Camino del Molino 2, 28942, Fuenlabrada, Madrid, Spain.
| | - Gabriela Lobo-Tamer
- Clinic and Dietetics Nutrition Unit, Hospital Virgen de las Nieves, Avda Fuerzas Armadas 2, 18014, Granada, Spain.
| | - Mercedes Zabarte-Martinez
- Intensive Care Unit, Hospital Universitario de Donostia, Paseo Dr. Beguiristain s/n, 20080, Donostia, Spain.
| | - Jose Ignacio Herrero-Meseguer
- Intensive Care Unit, Hospital Universitario de Bellvitge, C/ Feixa Llarga 1, 08907L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jose Acosta-Escribano
- Intensive Care Unit, Hospital General Universitario, C/ Pintor Baeza s/n, 03005, Alicante, Spain.
| | - Antonio Blesa-Malpica
- Intensive Care Unit, Hospital Clínico San Carlos, C/ Prof. Martín Lagos s/n, 28040, Madrid, Spain.
| | - Fátima Martinez-Lozano
- Intensive Care Unit, Hospital General Universitario Reina Sofía, Avda Intendente Jorge Palacios 1, 30003, Murcia, Spain.
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Ojo O, Brooke J. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review. Nutrients 2014; 6:5142-52. [PMID: 25412151 PMCID: PMC4245584 DOI: 10.3390/nu6115142] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 12/31/2022] Open
Abstract
The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education and Health, University of Greenwich, Avery Hill Road, Avery Hill Campus, London, SE9 2UG, UK.
| | - Joanne Brooke
- Faculty of Education and Health, University of Greenwich, Avery Hill Road, Avery Hill Campus, London, SE9 2UG, UK.
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Hamdy O, Ernst FR, Baumer D, Mustad V, Partridge J, Hegazi R. Differences in resource utilization between patients with diabetes receiving glycemia-targeted specialized nutrition vs standard nutrition formulas in U.S. hospitals. JPEN J Parenter Enteral Nutr 2014; 38:86S-91S. [PMID: 25227669 DOI: 10.1177/0148607114550315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of the study was to compare patient outcomes and costs for patients with diabetes mellitus (DM) receiving glycemia-targeted specialized nutrition (GTSN) with similar patients receiving standard nutrition (STDN) formulas during acute care hospitalizations. RESEARCH DESIGN AND METHODS The study was designed as a retrospective analysis over a 10-year period (2000-2009) of clinical and cost data from 125,000 hospital inpatient episodes in the Premier Research Database. Patients received either GTSN or STDN, by tube or orally, as a component of comprehensive care for hyperglycemia in patients with DM. To adjust for potential cohort imbalances, GTSN patients were matched with STDN patients on the basis of propensity scores, adjusting for many characteristics, including age, sex, race, All Patient Refined Diagnosis-Related Group (APR-DRG) illness severity, APR-DRG mortality risk, and comorbidities. RESULTS Tube-fed patients with DM who were provided GTSN had a 0.88-day (95% confidence interval [CI], 0.73-1.02) shorter length of hospital stay (LOS) on average compared with those patients provided STDN. Orally fed patients with DM who were provided GTSN had a 0.17-day (95% CI, 0.14-0.21) shorter LOS than did those patients provided STDN. The shorter LOS associated with GTSN contributed to a cost savings of $2586 for tube-fed patients and $1356 for orally fed patients. CONCLUSIONS The use of GTSN feeding formulas for patients with DM in acute care hospital settings was associated with reduced LOS and inpatient hospital episode cost in comparison to STDN.
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Affiliation(s)
- Osama Hamdy
- Joslin Diabetes Center, Boston, Massachusetts
| | - Frank R Ernst
- Premier healthcare alliance, Charlotte, North Carolina
| | | | - Vikkie Mustad
- Abbott Nutrition, Research & Development, Columbus, Ohio
| | | | - Refaat Hegazi
- Abbott Nutrition, Research & Development, Columbus, Ohio Department of Internal Medicine, The Brody School of Medicine, East Carolina University, North Carolina
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Dickerson RN, Maish GO, Minard G, Brown RO. Nutrition Support Team-Led Glycemic Control Program for Critically Ill Patients. Nutr Clin Pract 2014; 29:534-541. [DOI: 10.1177/0884533614530763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - George O. Maish
- Department of Surgery, University of Tennessee College of Medicine, Memphis
| | - Gayle Minard
- Department of Surgery, University of Tennessee College of Medicine, Memphis
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23
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Hamilton C, Boyce VJ. Addressing Malnutrition in Hospitalized Adults. JPEN J Parenter Enteral Nutr 2013; 37:808-15. [DOI: 10.1177/0148607113497224] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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24
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García-Rodríguez CE, Mesa MD, Olza J, Buccianti G, Pérez M, Moreno-Torres R, Pérez de la Cruz A, Gil Á. Postprandial glucose, insulin and gastrointestinal hormones in healthy and diabetic subjects fed a fructose-free and resistant starch type IV-enriched enteral formula. Eur J Nutr 2012. [DOI: 10.1007/s00394-012-0462-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Quilliot D, Malgras A, Zallot C, Ziegler O. Incrétines et nutrition entérale. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Ingestion of a high-molecular-weight hydrothermally modified waxy maize starch alters metabolic responses to prolonged exercise in trained cyclists. Nutrition 2011; 27:659-65. [DOI: 10.1016/j.nut.2010.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 11/20/2022]
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27
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Abstract
Both glycemic control and adequate nutrition support impact the clinical outcome of hospitalized patients. Providing nutrition to malnourished patients using the enteral or parenteral route may increase the risk of hyperglycemia, especially in patients with diabetes. Hyperglycemia can be managed through the use of enteral tube feeds with reduced carbohydrate content or limiting the carbohydrate concentration in parenteral formulas. Judicious use of insulin or other glucose-lowering medications synchronized with appropriate nutrition support allows for optimal inpatient glycemic control.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology and Metabolism, Beth Israel Medical Center, Albert Einstein College of Medicine, 55 East 34th Street, New York, NY 10016, USA.
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28
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Alish CJ, Garvey WT, Maki KC, Sacks GS, Hustead DS, Hegazi RA, Mustad VA. A diabetes-specific enteral formula improves glycemic variability in patients with type 2 diabetes. Diabetes Technol Ther 2010; 12:419-25. [PMID: 20470226 DOI: 10.1089/dia.2009.0185] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Well-controlled studies have demonstrated that inpatient hyperglycemia is an indicator of poor clinical outcomes, but the use of diabetes-specific enteral formulas in hospitalized patients remains a topic of great debate. METHODS In two different protocols, postprandial glycemia and insulinemia were measured in 22 subjects with diabetes fed a diabetes-specific or standard formula (protocol 1). Continuous glucose monitoring was used to assess glucose levels in 12 enterally fed patients with diabetes receiving the standard formula followed by the diabetes-specific formula continuously for 5 days each (protocol 2). End points included postprandial glycemia and insulinemia, glycemic variability (mean amplitude of glycemic excursions [MAGE]), mean glucose, and insulin use. RESULTS In the postprandial response protocol, the diabetes-specific formula resulted in lower positive areas under the postprandial curve (P < 0.001) and peak glucose (P < 0.001) and insulin (P = 0.017) levels. In the protocol using continuous glucose monitoring, glycemic variability (as measured by MAGE) was lower with continuous administration of the diabetes-specific than the standard formula (64.6 +/- 6.8 mg/dL vs. 110.6 +/-15.3 mg/dL, P = 0.003). Also, administration of the diabetes-specific formula resulted in lower mean glucose concentrations during feeding (171.1 +/- 16.1 vs. 202.1 +/- 17.4 mg/dL, P = 0.024) and insulin requirements (7.8 +/- 2.3 vs. 10.9 +/- 3.3 units/day, P = 0.039) than the standard formula. CONCLUSIONS Relative to the standard formula, the diabetes-specific formula reduced postprandial glycemia, mean glucose, glycemic variability, and short-acting insulin requirements. These results suggest potential clinical usefulness of a diabetes-specific enteral formula for minimizing glycemic excursions in hospitalized patients.
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Affiliation(s)
- Carolyn J Alish
- Abbott Nutrition, Abbott Laboratories, Columbus, Ohio 43215-1724, USA.
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29
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Effect of a low-calorie high nutritional value formula on weight loss in type 2 diabetes mellitus. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2010. [DOI: 10.1007/s12349-009-0050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition 2009; 25:1177-85. [DOI: 10.1016/j.nut.2009.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 04/07/2009] [Accepted: 04/07/2009] [Indexed: 11/22/2022]
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