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 - PubMed (original) (raw)
Randomized Controlled Trial
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
Vikkie A Mustad et al. BMJ Open Diabetes Res Care. 2020 Jul.
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.
Keywords: continuous glucose monitoring; nutrition intervention; self-management; type 2 diabetes.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Conflict of interest statement
Competing interests: VAM, RAH, DSH, ESB, and RR are Abbott employees and stockholders. KM and MP received research support for this study from Abbott Nutrition. JIM has consulted for Abbott Nutrition. RMB has received research support, consulted, or has been on the scientific advisory board for Abbott Nutrition, Abbott Diabetes Care, DexCom, Hygieia, Johnson & Johnson, Lilly, Medtronic, Novo Nordisk, Onduo, Roche, Sanofi, Senseonics and United Healthcare. His technology research is funded in part by NIH/NIDDK. RMB’s employer, non-profit HealthPartners Institute, contracts for his services and no personal income goes to RMB. OH received research support for this study from Abbott Nutrition and has consulted for Abbott Nutrition and Abbott Diabetes Care.
Figures
Figure 1
Study Consolidated Standards of Reporting Trials (CONSORT) flow diagram. Bkfst/AS, breakfast/afternoon snack; Bkfst/PBS, breakfast/prebed snack; DSNS, diabetes-specific nutritional shake.
Figure 2
Composite ambulatory glucose profiles for all participants in each treatment group during self-selected diet baseline (5+0.1 days) and during intervention phase (6+0.1 days). (A) Self-selected diet. (B) DSNS Bkfst/AS. (C) DSNS Bkfst/PBS. Bkfst/AS, breakfast/afternoon snack; Bkfst/PBS, breakfast/prebed snack; DSNS, diabetes-specific nutritional shake.
Figure 3
Mean+SEM glucose responses 0–120 min after breakfast (A), positive AUC (B), and peak value (C). Solid line or dark bar reflects glucose responses across the self-selected diet baseline phase (5+0.1 days); dashed line or light bar reflects glucose responses across the intervention phase (6+0.1 days). AUC, area under the curve; Bkfst/AS, breakfast/afternoon snack; Bkfst/PBS, breakfast/prebed snack; DSNS, diabetes-specific nutritional shake; IS, interstitial.
References
- Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015. Endocr Pract 2015;21 Suppl 1:1–87. 10.4158/EP15672.GLSUPPL - DOI - PMC - PubMed
- Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm - 2019 executive summary. Endocr Pract 2019;25:69–100. 10.4158/CS-2018-0535 - DOI - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Research Materials