Glycemic responses to glycemia-targeted specialized-nutrition beverages with varying carbohydrates compared to a standard nutritional beverage in adults with type 2 diabetes

Abstract

Background: Postprandial plasma glucose concentration is an important diabetes management target. Glycemia-targeted specialized-nutrition (GTSN) beverages, containing various quantities and types of carbohydrates (CHO), have been formulated to blunt postprandial hyperglycemia. The objective of this research was to evaluate the effectiveness of these products on postprandial glycemic and hormonal responses based on comparisons of GTSN with differing carbohydrate quantities or types. Methods: In two randomized, double-blind, crossover studies, participants (mean age 61 years) with type 2 diabetes consumed GTSN in a meal tolerance test. In the CHO Quantity Study, a standard nutritional beverage (STD) was compared to a low carbohydrate nutritional beverage with tapioca dextrin (GTSN-TDX) and a balanced carbohydrate nutritional beverage containing a blend of the slowly-digesting carbohydrates maltodextrin and sucromalt (GTSN-SDC). In the CHO Type Study, the GTSN beverages had similar carbohydrate quantities but varied in carbohydrate composition with GTSN-SDC compared to a formula with tapioca starch and fructose (GTSN-TS&F), and one with isomaltulose and resistant starch (GTSN-I&RS). Postprandial (0-240 min) concentrations of blood glucose, insulin (CHO Quantity Study only) and glucagon-like-peptide (GLP)-1 (CHO Quantity Study only) were measured. Results: Despite having substantially different carbohydrate quantities, the GTSN blunted the glucose positive area under the curve (AUC 0-240 min ) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC 0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC 0-240 min tended to be lower for GTSN-SDC (1477 ± 460) than GTSN-TS&F (2203 ± 412; p = 0.062) and GTSN-I&RS (2190 ± 412; p = 0.076). No differences were observed between GTSN-TS&F and GTSN-I&RS. Conclusions: These results demonstrate the effectiveness of several GTSN products and suggest that both CHO quantity and type play important roles in postprandial glycemic response in men and women with type 2 diabetes. Furthermore, GTSN products containing slow-digesting carbohydrates can blunt postmeal glucose and insulin concentration despite delivering greater total grams of CHO, which provides a dietary benefit for people with diabetes.