A randomized controlled clinical trial of carbohydrate mix-fortified nutrition in type 2 diabetes mellitus patients

  • Fatimah Eliana Department of Internal Medicine, Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
  • Budi Agung Pranoto PT Sanghiang Perkasa, Jakarta, Indonesia
Keywords: liquid meal replacement nutrition, low glycemic index, type 2 diabetes mellitus


BACKGROUND Liquid meal replacement nutrition (LMRN) contains low glycemic index food (isomaltulose, resistant dextrin, and inulin), which can decrease large blood glucose level fluctuations and reduce food intake. This study aimed to determine the stability of daily blood glucose and the level of appetite sensations after intake of LMRN in type 2 diabetes mellitus (DM) patients.

METHODS This randomized, controlled, crossover, and open-labeled study included 30 subjects with type 2 DM. Subjects attended two visit sessions to consume either LMRN or controlled-nutrition solid food (CNSF) for 4 consecutive days. Each subject had 2 days of 24-hour periods of blood glucose measurement using a continuous glucose monitoring system and had a 1-week washout period. Glycemic response (GR) and incremental area under the curve (iAUC) were calculated. The satiety level was measured using a visual analog scale.

RESULTS After 48 hours, LMRN reduced GR compared with CNSF with glucose measurements of 13.72 (30.42) and 17.47 (36.38) mg/dl, respectively. The reduction on iAUC after consuming LMRN (36,891 [30,255.8] mg.min/dl) compared with CNSF (40,641 [38,798.9] mg.min/dl) was also noted. Subjects having LMRN felt less hungry and more satiated than those consuming CNSF. The administration of LMRN does not have any serious side effects.

CONCLUSIONS LMRN provides a greater reduction of GR and longer term of satiety compared with CNSF without causing any serious side effects.


National Institute of Health Research and Development, Indonesian Ministry of Health. Main Results of Basic Health Research (RISKESDAS) 2018 [Internet]. Jakarta: National Institute of Health Research and Development, Indonesian Ministry of Health; 2018 [cited 26 Nov 2019]. Available from: http://www.kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf.

International Diabetes Federation. IDF diabetes atlas 8th edition [Internet]. Brussels: International Diabetes Federation; 2017 [cited 26 Nov 2019]. Available from https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html.

American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13-28. https://doi.org/10.2337/dc19-S002

Wahren J, Ekberg K. Splanchnic regulation of glucose production. Annu Rev Nutr. 2007;27:329-45. https://doi.org/10.1146/annurev.nutr.27.061406.093806

Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values. Am J Clin Nutr. 2002;76:5-56. https://doi.org/10.1093/ajcn/76.1.5

Thomas DE, Elliott EJ. Meta-analysis: the use of low-glycemic index diets in diabetes control. Br J Nutr. 2010;104:797-802. https://doi.org/10.1017/S0007114510001534

Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2003;26(8):2261-7. https://doi.org/10.2337/diacare.26.8.2261

Chen H, Shaw MJ, Moyer-Mileur L. The new glucose revolution: is the authoritative guide to the glycemic index the right dietary solution for lifelong health? Int J Nutr Metab. 2010;2(5):73-81. https://doi.org/10.5897/IJNAM.9000043

Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care. 2008;31(12):2281-3. https://doi.org/10.2337/dc08-1239

Kaur B, Ranawana V, Teh AL, Henry CJK. The impact of low glycemic index (GI) breakfast and snack on daily blood glucose profiles and food intake in young Chinese adult males. J Clin Translat Endocrinol. 2015;2(3):92-8. https://doi.org/10.1016/j.jcte.2015.05.002

The R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing Version 2.6.2 (2008-02-082008) [Internet]. 2003 [cited 26 Nov 2019]. Available from: http://softlibre.unizar.es/manuales/aplicaciones/r/fullrefman.pdf.

Allison DB, Paultre F, Maggio C, Mezzitis N, Pi-Sunyer FX. The use of areas under curves in diabetes research. Diabetes Care. 1995;18(2):245-50. https://doi.org/10.2337/diacare.18.2.245

University of Leeds (UNIVLEEDS). Satin (Satiety Innovation) - D4.3: Satiety Methodology. Work Package 4; 2016.

World Health Organization. Global report on diabetes [Internet]. Geneva: World Health Organization; 2016 [cited 26 Nov 2019]. Available from: https://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=82C4C9159548D8E8EBCED9341B4A8C7C?sequence=1.

Brouns F, Bjork I, Frayn KN, Gibbs AL, Lang V, Slama G, et al. Glycaemic index methodology. Nutr Res Rev. 2005;18(1):145-71. https://doi.org/10.1079/NRR2005100

Augustin LS, Kendall CW, Jenkins DJ, Willett WC, Astrup A, Barclay AW, et al. Glycemic index, glycemic load and glycemic response: An International scientific consensus summit from the International Carbohydrate Quality Consortium (ICQC). Nutr Metab Cardiovasc Dis. 2015;25(9):795-815. https://doi.org/10.1016/j.numecd.2015.05.005

Monnier L. Is postprandial glucose a neglected cardiovascular risk factor in type 2 diabetes? Eur J Clin Invest. 2000;30 Suppl 2:3-11. https://doi.org/10.1046/j.1365-2362.30.s2.2.x

Gribovschi M, Tgan S, Hancu N. Glycemic variability and type 2 diabetes mellitus. Appl Med Inform. 2013;32(1):53-60.

Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013;97(3):505-16. https://doi.org/10.3945/ajcn.112.042457

Maresch CC, Petry SF, Theis S, Bosy-Westhpal A, Linn T. Low glycemic index prototype isomaltulose-update of clinical trials. Nutrients. 2017;9(4):381. https://doi.org/10.3390/nu9040381

Bodinham CL, Smith L, Thomas EL, Bell JD, Swann JR, Costabile A, et al. Efficacy of increased resistant starch consumption in human type 2 diabetes. Endocr Connect. 2014;3(2):75-84. https://doi.org/10.1530/EC-14-0036

Mukai J, Tsuge Y, Yamada M, Otori K, Atsuda K. Effects of resistant dextrin for weight loss in overweight adults: a systematic review with a meta-analysis of randomized controlled trials. J Pharm Health Care Sci. 2017;3:15. https://doi.org/10.1186/s40780-017-0084-9

Aliasgharzadeh A, Dehghan P, Gargari BP, Asghari-Jafarabadi M. Resistant dextrin, as a prebiotic, improves insulin resistance and inflammation in women with type 2 diabetes: a randomized controlled clinical trial. Br J Nutr. 2015;113(2):321-30. https://doi.org/10.1017/S0007114514003675

Aliasgharzadeh A, Khalili M, Mirtaheri E, Gargari BP, Tavakoli F, Farhangi MA, et al. A combination of prebiotic inulin and oligofructose improve some of cardiovascular disease risk factors in women with type 2 diabetes: a randomized controlled clinical trial. Adv Pharm Bull. 2015;5(4):507-14. https://doi.org/10.15171/apb.2015.069

How to Cite
Eliana F, Pranoto BA. A randomized controlled clinical trial of carbohydrate mix-fortified nutrition in type 2 diabetes mellitus patients. Med J Indones [Internet]. 2020Aug.14 [cited 2024Mar.1];29(3):275-82. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/3398
Clinical Research