Meal replacement shake improves glucose response in type 2 diabetes
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Adults with type 2 diabetes who replaced their usual breakfast and an afternoon or evening snack with a nutritional shake experienced a 47% reduction in postmeal peak glucose after breakfast, according to findings from a pilot study.
“Nutrition is such a critical part in the management of any diabetes, but particularly type 2 diabetes,” Richard M. Bergenstal, MD, executive director of the International Diabetes Center Park Nicollet in Minneapolis, told Healio. “We wanted to evaluate if a different approach to nutrition could improve glucose control. We talk about it all the time, and no one is carefully studying it, particularly with new technology.”
Study design
In a randomized, open-label, parallel study, Bergenstal and colleagues analyzed data from eight clinical centers across the U.S. on 81 adults prescribed oral agents for management of type 2 diabetes (59% men; mean age, 62 years; mean BMI, 32 kg/m²; mean diabetes duration, 11 years). For a 6-day baseline period, participants followed their habitual, self-selected diets; glucose data were collected using the FreeStyle Libre Pro CGM system (Abbott), with data blinded to participants and staff.
After the baseline period, researchers randomly assigned participants, stratified by sex and medication type, to one of three groups for days 7 to 14. The self-selected diet group received no study product and were asked to maintain their usual diet and eating patterns (n = 32). The diabetes-specific nutritional shake (Glucerna Hunger Smart, Abbott) breakfast and afternoon group were instructed to consume one shake as a breakfast meal replacement and one as a mid-afternoon snack replacement (n = 24). A third group was instructed to consume a shake at breakfast and before bedtime (n = 25). Glucose was assessed by CGM throughout the study.
Ambulatory glucose profiles revealed a consistent late-morning/early afternoon elevation in glucose levels across groups, particularly prominent during the baseline phase, Bergenstal said.
“This was confirming, with good CGM technology, so we could say, ‘This is real,’” Bergenstal said in an interview. “Focus on that morning glucose, because no matter how well you are doing with medications, there is still room for improvement.”
During the intervention phase, all three groups reduced their 120-minute postprandial glycemic response and adjusted peak value, defined as the greatest change in interstitial glucose within 2 hours after the meal, compared with the interstitial glucose value before the meal, when compared with the baseline phase.
Researchers found that participants consuming a nutritional shake in place of their usual breakfast and a shake for afternoon snack showed greater reductions in positive area under the curve compared with the self-selected diet group (P = .008), with a similar but nonsignificant trend observed for participants in the bedtime snack shake group.
Compared with the self-selected diet group, adjusted peak value showed greater reductions for the afternoon snack shake group (P = .002) and the bedtime snack shake group (P = .01).
Nocturnal glucose variability decreased during the intervention phase compared with the baseline phase for participants in the afternoon snack shake group (P = .02), with no between-group differences.
Reduced cravings
After intervention, the breakfast and afternoon snack shake group had a lower percentage of participants reporting cravings for starchy meals/sides compared with before the study (17% vs. 33%; P = .046). This group also reported an increase in confidence in choosing foods to control their glucose response.
Bergenstal said the findings add to emerging research that suggests meal composition and timing may be important for glycemic response for individuals with type 2 diabetes.
“Never give up on modifying the meal plan and talking about nutrition, no matter what medication you are using,” Bergenstal said. “There is always room for improvement. This study reconfirms that meal substitution is one approach to get people started.”
For more information:
Richard M. Bergenstal, MD, can be reached at the International Diabetes Center, 3800 Park Nicollet Blvd., Minneapolis, MN 55416; email: richard.bergenstal@parknicollet.com.
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