Plasma glucose and insulin response to two oral nutrition supplements in adults with type 2 diabetes mellitus

Abstract

Objective The purpose of this clinical trial was to compare the glucose usage of two oral nutritional supplement (ONS) products and to assess whether a diabetes-specific formulation provides improved glucose stabilization and management compared with a standard formula. Research design and methods A total of 12 subjects with type 2 diabetes (7 males and 5 females) completed a randomized, cross-over design trial. Each subject consumed isocaloric amounts of either the standard ONS or the diabetes-specific formula ONS on different dates, 1 week apart. Glucose and insulin measures were recorded at baseline, and 10, 20, 30, 60, 90, 120, 150, 180, 210 and 240 min after the beverage was consumed and then used to calculate area under the curve (AUC) for each subject. Results The mean glucose AUC was lower in the diabetes-specific ONS group than in the standard group (p<0.0001), but there was not a significant difference observed for mean insulin AUC (p=0.068). A sensitivity analysis of the mean insulin AUC measures was performed by removing a potential outlier from the analysis, and this resulted in a significant difference between the groups (p=0.012). First-phase insulin measures and an insulinogenic index calculated for the beverages showed no significant differences. Conclusions On the basis of the results of this trial of 12 subjects, the diabetes-specific ONS appears to provide better glucose maintenance in persons with type 2 diabetes when compared to the standard formula ONS. Trial registration number NCT02612675.

Blood Glucose Response of a Low-Carbohydrate Oral Nutritional Supplement with Isomaltulose and Soluble Dietary Fiber in Individuals with Prediabetes: A Randomized, Single-Blind Crossover Trial

“…ONS with low amounts of AC or high percentages of carbohydrates with a low glycemic response in the AC have significantly lower postprandial blood glucose elevation. The ONS with half of the AC showed more than 60% lower iCmax than the standard ONS in postprandial blood glucose [11]. The ONS with 56% of the carbohydrate replaced with isomaltulose showed a 55% lower postprandial blood glucose iAUC than the standard ONS with similar proportions of macronutrients [12].…”

“…Second, it is difficult to assess the clinical benefit by comparing the glycemic response after a single dose with the standard ONS. Although many prior studies have used commercially available, commonly used ONS as the standard [10][11][12][13][14][15], their nutritional composition was not consistent. To assess the clinical usefulness of LC-ONS, it is desirable to compare it with products that are clinically useful in patients with diabetes or prediabetes [33,34].…”

“…The sample size was set to 20, with reference to previous studies using other diabetesspecialized ONS products [10,11,[13][14][15]. The baseline was calculated as the mean ± standard deviation or frequency.…”

“…There are three main strategies to suppress the postprandial blood glucose rise caused by ONS: (i) to reduce the energy proportion of available carbohydrates (AC, carbohydrates that are absorbed in the small intestine and increase blood glucose) and replace the energy with fat or protein [10,11]; (ii) using slowly digestible, low glycemic response-carbohydrates, such as isomaltulose and lactose as an AC source [12][13][14]; (iii) to increase the amount of soluble dietary fiber to slow down the rate of sugar absorption in the small intestine. To date, several ONS were developed that use these strategies alone or in combination and were reported to have lower postprandial blood glucose levels than standard ONS [10][11][12][13][14][15]. However, these products still have insufficient reports on the postprandial blood glucose levels; therefore, more evidence is required.…”