Effect of Oral Nutritional Supplements with Sucromalt and Isomaltulose versus Standard Formula on Glycaemic Index, Entero-Insular Axis Peptides and Subjective Appetite in Patients with Type 2 Diabetes: A Randomised Cross-Over Study

Abstract

Oral diabetes-specific nutritional supplements (ONS-D) induce favourable postprandial responses in subjects with type 2 diabetes (DM2), but they have not been correlated yet with incretin release and subjective appetite (SA). This randomised, double-blind, cross-over study compared postprandial effects of ONS-D with isomaltulose and sucromalt versus standard formula (ET) on glycaemic index (GI), insulin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1) and SA in 16 individuals with DM2. After overnight fasting, subjects consumed a portion of supplements containing 25 g of carbohydrates or reference food. Blood samples were collected at baseline and at 30, 60, 90, 120, 150 and 180 min; and SA sensations were assessed by a visual analogue scale on separate days. Glycaemic index values were low for ONS-D and intermediate for ET (p < 0.001). The insulin area under the curve (AUC_{0-180 min}) (p < 0.02) and GIP AUC (p < 0.02) were lower after ONS-D and higher GLP-1 AUC when compared with ET (p < 0.05). Subjective appetite AUC was greater after ET than ONS-D (p < 0.05). Interactions between hormones, hunger, fullness and GI were found, but not within the ratings of SA; isomaltulose and sucromalt may have influenced these factors.

Keywords: glycaemic index; incretins; isomaltulose; nutritional supplement; subjective appetite; sucromalt.

Figure 1

Time course and AUC_{0–180 min} of serum glucose, insulin GIP and GPL-1 concentrations following ingestions of GB, ET, GS and DI. (A) Glucose in relation with time and AUC_{0–180 min}, (B) insulin in relation with time and AUC_{0–180 min}, (C) GIP in relation with time and AUC_{0–180 min}, and (D) GLP-1 in relation with time and AUC_{0–180 min} for all the different types of treatments. Data are expressed as means ± SEM; n = 16. The same colour scheme was used for all the graphs. All AUC_{0–180 min} means significant differences (p < 0.02) in each group. Treatment groups: (GB) Glucose solution or reference product; (ET) standard nutritional supplement not specific for diabetics; (GS) resistant maltodextrin and sucromalt supplement; (DI) isomaltulose and resistant starch supplement. GIP: glucose-dependent insulinotropic polypeptide; GLP-1: glucagon-like peptide 1.

Figure 2

Time course and formula of postprandial perception of hunger, desire to eat, fullness, prospective food consumption, subjective appetite and AUC_{0–180 min} values following ingestions of GB, ET, GS and DI. (A) hunger in relation with time and formula; (B) desire to eat in relation with time and formula, (C) fullness in relation to time and formula, (D) prospective food consumption in relation with time and formula and (E) subjective appetite in relation with time and formula. Data are expressed as means ± SEM, (n = 16). Data comparisons about differences in subjective measurements of appetite according to consumption tests are described in Table 5. The same colour scheme was used for all graphs. All means of AUC_{0–180 min} showed significant differences (p < 0.02) in each group. Treatment groups: (ET) standard nutritional supplement not specifically for people with diabetes. (GS) Resistant maltodextrin and sucromalt supplement. (DI) Isomaltulose and resistant starch supplement.