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Peres M, Costa HS, Silva MA, Albuquerque TG. The Health Effects of Low Glycemic Index and Low Glycemic Load Interventions on Prediabetes and Type 2 Diabetes Mellitus: A Literature Review of RCTs. Nutrients 2023; 15:5060. [PMID: 38140319 PMCID: PMC10746079 DOI: 10.3390/nu15245060] [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: 11/03/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Diets with a low glycemic index (GI) and a low glycemic load (GL) can improve glycemic control, blood lipids, blood pressure and BMI in prediabetes and type 2 diabetes (T2DM), but evidence regarding other aspects of cardiometabolic health is limited. We searched the literature for RCTs published from 2013 to 2023 and reviewed the evidence on low-GI/GL diets and their effects on different aspects of health in prediabetes and T2DM, aiming to build a report on all relevant outcomes included in the studies. We included 14 RCTs with 1055 participants, who were mostly middle-aged individuals with T2DM. Interventions were mostly low GI and lasted 1-36 months. Low-GI/GL foods and diets showed benefits in terms of short-term glycemic control, weight and adiposity. Longer-term trials would be necessary to determine whether these benefits persist over time and/or lead to lower CVD risk and mortality. Effects on lipid profile were inconsistent. Some studies also reported positive effects of low-GI/GL interventions on blood pressure, inflammatory biomarkers, renal function and gut microbiota composition. Future trials should focus on some of these novel outcome measures, which may provide important insights into the metabolic effects of low-GI diets on individuals with diabetes.
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Affiliation(s)
- Maria Peres
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
| | - Helena S. Costa
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Mafalda Alexandra Silva
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
| | - Tânia Gonçalves Albuquerque
- Research and Development Unit, Department of Food and Nutrition, National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016 Lisbon, Portugal; (M.P.); (M.A.S.); (T.G.A.)
- REQUIMTE-LAQV, Faculty of Pharmacy, University of Oporto, Rua Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
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Ye W, Xu L, Ye Y, Zeng F, Lu X, Li Y, Liu L. Efficacy and Safety of Meal Replacement in Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2023; 108:3041-3049. [PMID: 37192345 DOI: 10.1210/clinem/dgad273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023]
Abstract
CONTEXT Meal replacement (MR) is beneficial for the management of type 2 diabetes (T2D). However, MR prescription and patient characteristics vary substantially between studies using MR in T2D patients. OBJECTIVE This work aimed to evaluate the efficacy and safety of MR in T2D patients by meta-analysis, with a focus on subgroup analysis of variable participant characteristics and MR prescription. METHODS We searched PubMed, CENTRAL, Embase, Web of Science, and the clinical trial registration database up to March 2022. We included randomized controlled trials (RCTs) of 2 weeks or more assessing the effect and safety of MR in T2D patients in comparison with conventional diabetic diets (CDs). RESULTS A total of 17 RCTs involving 2112 participants were ultimately included. Compared with CDs, MR significantly reduced glycated hemoglobin A1c (HbA1c) (MD -0.46%; P < .001), fasting blood glucose (FBG, -0.62 mmol/L; P < .001), body weight (-2.43 kg; P < .001), and body mass index (BMI, -0.65; P < .001), and improved other cardiometabolic risk factors. In subgroup analyses, total MR showed greater improvement in HbA1c (-0.72% vs -0.32%; P = .01), FBG (-1.45 vs -0.56 mmol/L; P = .02), body weight (-6.57 vs -1.58 kg; P < .001), and BMI (-2.78 vs -0.37; P < .001) than partial MR. MR with caloric restriction showed more reduction in body weight (-3.20 vs -0.75 kg; P < .001) and BMI (-0.84 vs -0.24; P = .003) compared with those without caloric restriction. MR showed similar benefits in studies that included patients using insulin and those that did not. Both partial and total MR were well tolerated. CONCLUSION Compared with CDs, the MR-based dietary pattern further improved the glycemic control and adipose indicators in T2D patients. Appropriate calorie restriction and total MR might be more beneficial, while both patients treated with or without insulin treatment could similarly benefit from MR usage.
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Affiliation(s)
- Wenjing Ye
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Lijuan Xu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangdong, 510632, China
| | - Xin Lu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Liehua Liu
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
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Dharmalingam M, Das R, Jain S, Gupta S, Gupta M, Kudrigikar V, Bachani D, Mehta S, Joglekar S. Impact of Partial Meal Replacement on Glycemic Levels and Body Weight in Indian Patients with Type 2 Diabetes (PRIDE): A Randomized Controlled Study. Diabetes Ther 2022; 13:1599-1619. [PMID: 35834107 PMCID: PMC9281377 DOI: 10.1007/s13300-022-01294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Partial meal replacement (PMR) offers potential glycemic and weight control benefits in type 2 diabetes mellitus (T2DM) patients. We evaluated the clinical impact of PMR (diabetes-specific nutritional supplement [DSNS]) in overweight/obese Indian patients with T2DM. METHODS PRIDE, a 12-week, phase IV, open-label, multicenter study randomized (1:1) newly diagnosed T2DM patients (≤ 1 year) to either DSNS plus standard of care (SOC; diabetes treatment with dietary counseling) group (PMR) or SOC alone group (SOC). The primary endpoint was mean change in glycated hemoglobin (HbA1c) from baseline to week 12. Secondary endpoints were changes in glucose profiles, body weight, waist circumference, lipid profile, and factors impacting quality-of-life (QoL) at week 6 and 12 from baseline. Safety was assessed throughout the study. RESULTS Of the 176 patients enrolled, 171 (n = 85 in PMR group; n = 86 in SOC group) were included in the modified intent-to-treat population. The mean reduction in HbA1c at week 12 from baseline in PMR group was significant compared to the SOC group (- 0.59 vs. - 0.21%, p = 0.002). At week 12, the PMR group showed significant reduction in mean body weight (- 2.19 vs. - 0.22 kg; p = 0.001) and waist circumference (- 2.34 vs. - 0.48 cm; p = 0.001) compared to SOC group. Mean fasting plasma glucose and post-prandial glucose significantly reduced from baseline at week 6 and 12 in each group (p < 0.05). No significant change was observed in lipid profile. QoL parameters (treatment adherence, general well-being, and energy fulfilment) in the PMR were significantly better than SOC group (p < 0.05). Patients were satisfied with the taste of DSNS. No serious adverse events were reported. CONCLUSIONS DSNS is an encouraging option for PMR strategy, as it significantly improved HbA1c, body weight, waist circumference, and overall well-being among overweight/obese Indian T2DM patients. TRIAL IDENTIFICATION NO CTRI/2019/10/021595.
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Affiliation(s)
- Mala Dharmalingam
- Endocrinology and Diabetes Research Center and Laboratory, Bangalore, 560003, India
| | - Rupam Das
- Downtown Hospital, Guwahati, 781006, India
| | - Sandeep Jain
- Marudhar Hospital, Jaipur, Rajasthan, 302012, India
| | - Sachin Gupta
- Shubham Multispeciality Hospital, Amraiwadi, Ahmedabad, 380026, India
| | - Manoj Gupta
- Health Point Hospital, Kolkata, 700025, India
| | - Vinay Kudrigikar
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India.
| | - Deepak Bachani
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
| | - Suyog Mehta
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
| | - Sadhna Joglekar
- India Medical Affairs, Sun Pharma Laboratories Ltd., Sun House, Plot No. 201 8/1, Western Express Highway, Goregaon (E), Mumbai, Maharashtra, 400063, India
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Lew LC, Mat Ludin AF, Shahar S, Abdul Manaf Z, Mohd Tohit N. Efficacy and Sustainability of Diabetes-Specific Meal Replacement on Obese and Overweight Type-2 Diabetes Mellitus Patients: Study Approaches for a Randomised Controlled Trial and Impact of COVID-19 on Trial Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074188. [PMID: 35409872 PMCID: PMC8998339 DOI: 10.3390/ijerph19074188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
Meal replacement (MR) is widely used in weight and diabetes management programs due to its ease of compliance and handling. However, little is known about its impact on outcomes other than glycaemic control and weight loss. Furthermore, not many studies evaluate its cost-effectiveness and sustainability. This study aimed to evaluate the efficacy of a diabetes-specific MR for the weight reduction and glycaemic controls of overweight and obese T2DM patients, as compared to routine dietary consultation. Other health outcomes, the cost effectiveness, and the sustainability of the MR will also be evaluated. Materials and Methods: This randomised controlled clinical trial will involve 156 participants who have been randomised equally into the intervention and control groups. As a baseline, both groups will receive diet consultation. Additionally, the intervention group will receive an MR to replace one meal for 5 days a week. The duration of intervention will be 12 weeks, with 36 weeks of follow-up to monitor the sustainability of the MR. The primary endpoints are weight and Hemoglobin A1c (HbA1c) reduction, while the secondary endpoints are anthropometry, biochemical measurements, satiety, hormone changes, quality of life, and cost-effectiveness. The impact of the COVID-19 pandemic on study design is also discussed in this paper. This study has obtained human ethics approval from RECUKM (JEP-2019-566) and is registered at the Thai Clinical Trials Registry (TCTR ID: TCTR20210921004).
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Affiliation(s)
- Leong Chen Lew
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Correspondence: ; Tel.: +603-92898043
| | - Suzana Shahar
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Zahara Abdul Manaf
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, University Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur 56000, Malaysia;
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