New Tools for the Diabetes Toolbox

November is National Diabetes Month. The prevalence of diabetes increases with age, and more than one in four Americans ages 65 or older has the condition. Diabetes is a high priority for the Health and Human Services’ Office of Minority Health and Health Equity because “racial and ethnic minorities have a higher burden of diabetes, worse diabetes control and are more likely to experience complications.”

One way to help limit complications is to optimize blood glucose control. Recent research shows that taking a different approach to blood glucose monitoring and nutrition could be new tools for the diabetes toolbox.

With technology advancements, continuous glucose monitors (CGMs) have become increasingly accessible and effective for individuals with Type 2 diabetes. Type 2 diabetes is caused by a combination of insulin resistance and a relative insulin deficiency and is the most common form of diabetes, representing more than 90 percent of diagnosed cases. CGMs are inserted under the skin, can remain in place for up to 14 days and then removed, and the data collected during the time of insertion can be uploaded to the cloud via a smartphone. One big advantage of CGMs is the devices provide real-time biofeedback. Individuals can observe which foods and activities may most affect their blood glucose.

Nutrition is a fundamental part of diabetes treatment. Diabetes-specific nutrition shakes can provide protein, antioxidants, vitamins and minerals, as well as slow-release carbohydrates. For individuals with Type 2 diabetes, use of diabetes-specific nutrition shakes as meal replacements or snacks can provide balanced nutrition and result in a lower increase in blood glucose versus eating some other types of foods.

Many of the nutrient ingredients of diabetes-specific formulas stimulate the secretion of GLP-1, an important hormone-like peptide secreted by the gut to stimulate insulin secretion by the pancreas. Diabetes-specific nutrition shakes have been included in diabetes treatment guidelines to help support adherence to specific diet and nutrition recommendations.

New Pilot Study Paired Glucose Monitors With Diabetes-specific Nutritional Shakes

A recent randomized clinical pilot study for the first-time paired use of CGMs and diabetes-specific nutritional shakes and was published in BMJ Open Diabetes Research & Care. The study helped determine the impact of diabetes-specific nutrition shakes on blood glucose, both immediately and across the day. The study sample of 81 adults with Type 2 diabetes managed by oral glucose-lowering medications had an average age of 62.

For the study, all participants followed their usual diets and eating patterns for six days. Then between days 7 and 14, one group made no changes and continued their usual diets and eating patterns. Another group consumed a diabetes-specific nutrition shake in place of breakfast and a mid-afternoon snack. A third group consumed the shake at breakfast and as a snack before going to bed. Blood glucose was assessed by CGM throughout the study. Participants also were asked questions about their snacking behaviors, cravings and about their use of diabetes-specific nutrition supplements as meal replacements and snacks.

The study results showed:

  • Blood glucose responses at breakfast improved when individuals replaced their breakfast with a diabetes-specific nutrition shake compared to those who followed their usual diets.
  • Individuals who replaced breakfast and a snack with a diabetes-specific nutrition shake had reduced night-time variability in their blood glucose compared to their baseline (six days before they started consuming the product).
  • Individuals who replaced breakfast and their afternoon snack with a diabetes-specific nutrition supplement had significantly reduced cravings for starchy foods compared to their baseline. This same group also reported an increase in confidence in choosing foods to control their glucose response.

Self-management to Reach Health Goals

The American Diabetes Association confirmed in its consensus report on nutrition therapy that there is strong evidence supporting the efficacy and cost-effectiveness of nutrition therapy as a component of quality diabetes care. Yet they also clarified there is no “one-size-fits-all” eating plan for managing diabetes and “research provides clarity on many food choices and eating patterns that can help people achieve health goals and quality of life.”

There can be many reasons why individuals with diabetes may find it difficult to follow specific diet plans, including lack of control over eating high-carbohydrate foods and food cravings. The study authors suggested that replacing breakfast and an afternoon snack with a diabetes-specific nutrition supplement can improve blood glucose levels and can “lead to increased overall feeling of control over food choices.”

They concluded that use of these products as daily breakfast and afternoon snack replacements may help “reduce barriers and facilitate dietary self-management of diabetes.” These findings underscore how CGMs and diabetes-specific nutrition supplements can be helpful tools in the toolbox for assisting older adults with diabetes to reach their health and quality of life goals.

Refaat A. Hegazi, MD, PhD, MPH, is the head of Global Medical Affairs for Nutrition at Abbott and is based in Columbus Ohio.