Unique Shake Improves Glycemic Control in T2D

A clinical pilot study reveals a new way to improve glycemic control by replacing daily breakfast and afternoon snacks with a diabetes-specific nutritional shake. 

People with diabetes need to be conscious of food intake, and have a strict adherence to maintaining a controlled diet, because of the direct impact food has on their blood glucose levels. It is essential to eat healthy foods and limit the amounts of particular foods. Dr. Richard Bergenstal and colleagues wanted to evaluate a different approach to a diabetic diet regimen, one that implements nutritional shakes to replace meals and improve glucose levels. According to Dr. Bergenstal, “this study reconfirms that meal substitution is one approach to get people started.” It is vital to find a regimen that is easy to adapt to, such as drinking a premade shake instead of preparing a whole meal, and more successful in lowering blood glucose. 

A randomized, open-label, three-group parallel study was conducted with 81 patients with type 2 diabetes on oral medications. The study had two phases:  baseline and intervention, taking place over two weeks. The baseline phase was the first 6-days, during which participants were told to consume their healthy regular diet. The following seven to fourteen days, the participants entered the intervention phase. Blood sugar levels were collected using the Freestyle Libre Pro CGM system. Participants were randomized into three groups. The self-selected diet group (n=32) consumed their regular diet with no intervention. 

In contrast, the other two groups followed a diet variation with an intervention: a nutritional, diabetic specific shake. One of these two groups replaced their breakfast and mid-afternoon snack with the diabetic specific nutritional shake (n=24). In contrast, the other replaced their breakfast and pre-bed snack with the diabetic specific nutritional shake (n=25). All participants had glucose CGM monitored throughout the study. Also, patients were asked questions about their experience including the shake in their diet, to determine changes in snack cravings and snacking behaviors. A diabetic nutrition shake is an effortless way to keep track of calories while getting the proper nutrition. 

The study results showed that all groups had reduced their postprandial response when compared to the baseline results. Patients in the control group also improved in the intervention phase because they changed their behavior of their own accord during the study without the shake intervention.  In the analysis, participants who replaced their breakfast and afternoon snack with the nutritional shake showed more improvement in their blood glucose levels than those who had a self-selected diet (P=0.008). There was a nonsignificant trend between the breakfast and mid-afternoon snack groups and breakfast and pre-bed groups (0.069). The adjusted peak value showed a more significant reduction for the breakfast and mid-afternoon snack group (p=0.002) and breakfast and pre-bed group (p=0.01) compared to the self-selected diet group. The breakfast and afternoon snack group showed a reduction of 47% in their post-meal peak glucose. Nocturnal glucose variability significantly decreased during the breakfast and mid-afternoon group (p=0.020), but there were no significant differences between groups. After completing the study, the breakfast and mid-afternoon snack group had 17% fewer cravings for starchy meals and foods than at baseline, when it was 33%. This group also showed increased confidence to choose food, from 58.3% to 91.7% after the study was completed. Patients with diabetes must make healthy choices with food and continue to improve their glucose levels, and doing this will help reduce cravings. 

The diabetic specific nutritional shake improved postprandial glucose of type 2 patients under experimental monitoring conditions. Although this was true for the empirical study, more research is required on patients who are not confined in a controlled environment to study the impacts of this diet change in their everyday lives. Further investigation is needed to analyze the significance of meal replacements for patients with type 2 diabetes. Still, diabetes-specific nutritional shakes may be an alternative to the conventional diet for patients with type 2 diabetes. Also, for patients with a hectic schedule or no time to make a healthy meal, this can be a convenient alternative to help patients take control of their glucose levels. It is crucial to establish a diet routine that is formulated to work with a daily schedule. It is important to encourage patients to take control of glucose by implementing a healthy diet. Patients with diabetes should check their blood glucose levels multiple times a day to determine how certain foods impact their glucose levels, and the addition of a nutritional shake can encourage this healthy behavior. 

Practice Pearls:  

• In this experimental study, diabetes-specific nutritional shakes show improvement for postprandial glucose. 
• Consuming a diabetes-specific nutritional shake as a replacement for breakfast and snacks decreased glucose levels and improved healthy behaviors to maintain better glucose levels. 
• Cravings for starchy foods were reduced for participants who replaced a meal and an afternoon snack with a diabetes-specific nutritional shake compared to baseline results. 

Mustad, Vikkie A, et al. “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 

Aleksandra Kusic, PharmD Candidate, Florida A&M University, College of Pharmacy and Pharmaceutical Sciences