Skip to main content Accessibility help
×
Home

Breakfast replacement with a liquid formula improves glycaemic variability in patients with type 2 diabetes: a randomised clinical trial

  • Jiahui Peng (a1), Jingyi Lu (a1), Xiaojing Ma (a1), Lingwen Ying (a1), Wei Lu (a1), Wei Zhu (a1), Yuqian Bao (a1) and Jian Zhou (a1)...

Abstract

There is emerging evidence that glycaemic variability (GV) plays an important role in the development of diabetic complications. The current study aimed to compare the effects of lifestyle intervention (LI) with and without partial meal replacement (MR) on GV. A total of 123 patients with newly diagnosed and untreated type 2 diabetes (T2D) were randomised to receive either LI together with breakfast replacement with a liquid formula (LI+MR) (n 62) or LI alone (n 61) for 4 weeks and completed the study. Each participant was instructed to have three main meals per d and underwent 72-h continuous glucose monitoring (CGM) both before and after intervention. Measures of GV assessed by CGM included the incremental AUC of postprandial blood glucose (AUCpp), standard deviation of blood glucose (SDBG), glucose CV and mean amplitude of glycaemic excursions (MAGE). After a 4-week intervention, the improvements in systolic blood pressure (P=0·046) and time in range (P=0·033) were more pronounced in the LI+MR group than in the LI group. Furthermore, LI+MR caused significantly greater improvements in all GV metrics including SDBG (P=0·005), CV (P=0·002), MAGE (P=0·016) and AUCpp (P<0·001) than did LI. LI+MR (v. LI) was independently associated with improvements in GV after adjustment of covariates (all P<0·05). Our study showed that LI+MR led to significantly greater improvements in GV compared with LI, suggesting that LI+MR could be an effective treatment to alleviate glucose excursions.

Copyright

Corresponding author

*Corresponding authors: X. Ma, fax +86 21 64368031, email maxiaojing@sjtu.edu.cn; J. Zhou, fax +86 21 64368031, email zhoujian@sjtu.edu.cn

Footnotes

Hide All

These two authors contributed equally to this work.

Footnotes

References

Hide All
1. American Diabetes Association (2018) 4. Lifestyle management: Standards of Medical Care in Diabetes-2018. Diabetes Care 41, Suppl. 41, S38S50.
2. Chaiyasoot, K, Sarasak, R, Pheungruang, B, et al. (2018) Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial. Nutr Diabetes 8, 23.
3. Gulati, S, Misra, A, Tiwari, R, et al. (2017) Effect of high-protein meal replacement on weight and cardiometabolic profile in overweight/obese Asian Indians in North India. Br J Nutr 117, 15311540.
4. Kempf, K, Schloot, NC, Gartner, B, et al. (2014) Meal replacement reduces insulin requirement, HbA1c and weight long-term in type 2 diabetes patients with >100 U insulin per day. J Hum Nutr Diet 27, Suppl. 2, 2127.
5. Leader, NJ, Ryan, L, Molyneaux, L, et al. (2013) How best to use partial meal replacement in managing overweight or obese patients with poorly controlled type 2 diabetes. Obesity (Silver Spring) 21, 251253.
6. Xu, DF, Sun, JQ, Chen, M, et al. (2013) Effects of lifestyle intervention and meal replacement on glycaemic and body-weight control in Chinese subjects with impaired glucose regulation: a 1-year randomised controlled trial. Br J Nutr 109, 487492.
7. Gonzalez-Ortiz, M, Martinez-Abundis, E, Hernandez-Salazar, E, et al. (2006) Effect of a nutritional liquid supplement designed for the patient with diabetes mellitus (Glucerna SR) on the postprandial glucose state, insulin secretion and insulin sensitivity in healthy subjects. Diabetes Obes Metab 8, 331335.
8. Wang, WQ, Zhang, YF, Zhou, DJ, et al. (2008) Open-label, randomized, multiple-center, parallel study comparing glycemic responses and safety profiles of Glucerna versus Fresubin in subjects of type 2 diabetes mellitus. Endocrine 33, 4552.
9. Stenvers, DJ, Schouten, LJ, Jurgens, J, et al. (2014) Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: a randomised clinical trial. Br J Nutr 112, 504512.
10. Monnier, L, Colette, C & Owens, D (2012) The glycemic triumvirate and diabetic complications: is the whole greater than the sum of its component parts? Diabetes Res Clin Pract 95, 303311.
11. Suh, S & Kim, JH (2015) Glycemic variability: how do we measure it and why is it important? Diabetes Metab J 39, 273282.
12. Diabetes Control and Complications Trial Research Group, Nathan, DM, Genuth, S, et al. (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329, 977986.
13. Holman, RR, Paul, SK, Bethel, MA, et al. (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359, 15771589.
14. Writing Group for the DERG, Orchard, TJ, Nathan, DM, et al.. (2015) Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. JAMA 313, 4553.
15. Picconi, F, Parravano, M, Ylli, D, et al. (2017) Retinal neurodegeneration in patients with type 1 diabetes mellitus: the role of glycemic variability. Acta Diabetol 54, 489497.
16. Soupal, J, Skrha, J Jr, Fajmon, M, et al. (2014) Glycemic variability is higher in type 1 diabetes patients with microvascular complications irrespective of glycemic control. Diabetes Technol Ther 16, 198203.
17. Matsutani, D, Sakamoto, M, Iuchi, H, et al. (2018) Glycemic variability in continuous glucose monitoring is inversely associated with baroreflex sensitivity in type 2 diabetes: a preliminary report. Cardiovasc Diabetol 17, 36.
18. Su, G, Mi, S, Tao, H, et al. (2011) Association of glycemic variability and the presence and severity of coronary artery disease in patients with type 2 diabetes. Cardiovasc Diabetol 10, 19.
19. Horvath, EM, Benko, R, Kiss, L, et al. (2009) Rapid ‘glycaemic swings’ induce nitrosative stress, activate poly(ADP-ribose) polymerase and impair endothelial function in a rat model of diabetes mellitus. Diabetologia 52, 952961.
20. Quagliaro, L, Piconi, L, Assaloni, R, et al. (2003) Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: the role of protein kinase C and NAD(P)H-oxidase activation. Diabetes 52, 27952804.
21. Monnier, L, Mas, E, Ginet, C, et al. (2006) Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 295, 16811687.
22. Wentholt, IM, Kulik, W, Michels, RP, et al. (2008) Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes. Diabetologia 51, 183190.
23. Brownlee, M (2005) The pathobiology of diabetic complications: a unifying mechanism. Diabetes 54, 16151625.
24. Lu, J, Ma, X, Zhou, J, et al. (2018) Association of time in range, as assessed by continuous glucose monitoring, with diabetic retinopathy in type 2 diabetes. Diabetes Care 41, 23702376.
25. Matsuda, M & DeFronzo, RA (1999) Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 22, 14621470.
26. Cavalot, F, Pagliarino, A, Valle, M, et al. (2011) Postprandial blood glucose predicts cardiovascular events and all-cause mortality in type 2 diabetes in a 14-year follow-up: lessons from the San Luigi Gonzaga Diabetes Study. Diabetes Care 34, 22372243.
27. Coutinho, M, Gerstein, HC, Wang, Y, et al. (1999) The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 22, 233240.
28. Sartore, G, Chilelli, NC, Burlina, S, et al. (2013) Association between glucose variability as assessed by continuous glucose monitoring (CGM) and diabetic retinopathy in type 1 and type 2 diabetes. Acta Diabetol 50, 437442.
29. Wang, X, Zhao, X, Dorje, T, et al. (2014) Glycemic variability predicts cardiovascular complications in acute myocardial infarction patients with type 2 diabetes mellitus. Int J Cardiol 172, 498500.
30. Zhou, J, Martin, RJ, Tulley, RT, et al. (2008) Dietary resistant starch upregulates total GLP-1 and PYY in a sustained day-long manner through fermentation in rodents. Am J Physiol Endocrinol Metab 295, E11601166.
31. Zhao, L, Zhang, F, Ding, X, et al. (2018) Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes. Science 359, 11511156.
32. Holst, JJ (2007) The physiology of glucagon-like peptide 1. Physiol Rev 87, 14091439.
33. Shen, J, Chen, Z, Chen, C, et al. (2013) Impact of incretin on early-phase insulin secretion and glucose excursion. Endocrine 44, 403410.
34. Jakubowicz, D, Wainstein, J, Ahren, B, et al. (2015) Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care 38, 18201826.
35. Jakubowicz, D, Wainstein, J, Landau, Z, et al. (2017) Influences of breakfast on clock gene expression and postprandial glycemia in healthy individuals and individuals with diabetes: a randomized clinical trial. Diabetes Care 40, 15731579.
36. Danne, T, Nimri, R, Battelino, T, et al. (2017) International consensus on use of continuous glucose monitoring. Diabetes Care 40, 16311640.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed