title: Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: a randomised clinical trial.
abstract: Low-glycaemic index diets reduce glycated Hb (HbA1c) in patients with type 2 diabetes, but require intensive dietary support. Using a liquid meal replacement with a low glycaemic response (GR) may be an alternative dietary approach. In the present study, we investigated whether breakfast replacement with a low-GR liquid meal would reduce postprandial glycaemia and/or improve long-term glycaemia. In the present randomised, controlled, cross-over design, twenty patients with type 2 diabetes consumed either a breakfast replacement consisting of an isoenergetic amount of Glucerna SR or a free-choice breakfast for 3 months. Postprandial AUC levels were measured using continuous glucose measurement at home. After the 3-month dietary period, meal profiles and oral glucose tolerance were assessed in the clinical setting. The low-GR liquid meal replacement reduced the AUC of postprandial glucose excursions at home compared with a free-choice control breakfast (estimated marginal mean 141 (95 % CI 114, 174) v. estimated marginal mean 259 (95 % CI 211, 318) mmol × min/l; P= 0·0002). The low-GR liquid meal replacement also reduced glucose AUC levels in the clinical setting compared with an isoenergetic control breakfast (low GR: median 97 (interquartile range (IQR) 60-188) mmol × min/l; control: median 253 (IQR 162-386) mmol × min/l; P< 0·001). However, the 3-month low-GR liquid meal replacement did not affect fasting plasma glucose, HbA1c or lipid levels, and even slightly reduced oral glucose tolerance. In conclusion, the low-GR liquid meal replacement is a potential dietary approach to reduce postprandial glycaemia in patients with type 2 diabetes. However, clinical trials into the effects of replacing multiple meals on long-term glycaemia in poorly controlled patients are required before a low-GR liquid meal replacement can be adopted as a dietary approach to the treatment of type 2 diabetes.
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Stenvers
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Lydia J
authors.initials: LJ
authors.lastname: Schouten
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Jordy
authors.initials: J
authors.lastname: Jurgens
authors.affiliation: Laboratory of Endocrinology, Department of Clinical Chemistry, Academic Medical Center (AMC), University of Amsterdam,Amsterdam,The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Endert
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Andries
authors.initials: A
authors.lastname: Kalsbeek
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Fliers
authors.affiliation: Department of Endocrinology and Metabolism,Academic Medical Center (AMC), Room F5-165, University of Amsterdam,PO Box 22660,1100 DDAmsterdam,The Netherlands.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Bisschop
mesh_terms: D000368:Aged; D001628:Beverages / Q000009:adverse effects; D062408:Breakfast; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000178:diet therapy* / Q000378:metabolism; D003927:Diet, Diabetic / Q000009:adverse effects / Q000379:methods*; D004040:Dietary Carbohydrates / Q000009:adverse effects / Q000627:therapeutic use; D004042:Dietary Fats, Unsaturated / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects; D018149:Glucose Intolerance / Q000517:prevention & control; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010352:Patient Dropouts; D019518:Postprandial Period; D012307:Risk Factors
chemical_list: D004040:Dietary Carbohydrates; D004042:Dietary Fats, Unsaturated; D006442:Glycated Hemoglobin; C530986:Glucerna; C517652:hemoglobin A1c protein, human