Commentary By: Osama Hamdy, MD, Phd, Joslin Diabetes Center’s Medical Director, Obesity Clinical Program and Director of Inpatient Diabetes Program
Good nutrition has long been recognized as a key tenet of diabetes management. Those who take the time to learn about and implement good nutrition and lifestyle modifications, including regular exercise and medication adjustments, can make huge progress in their diabetes control.
Similar to how other aspects of diabetes management have evolved and progressed with the introduction of new tools and technology, the knowledge and understanding of the role of nutrition in diabetes management has also advanced thanks to science.
Very Low-Calorie Diets and Type 2 Diabetes Remission
Recent research shows that remission of type 2 diabetes is possible for some individuals using certain interventions, like following very low-calorie diets.[1]
We have seen encouraging results when individuals with type 2 diabetes participate in a multifaceted weight management program. Following a very low-calorie diet and time-restricted fasting for 16 hours helps individuals with type 2 diabetes lose weight, which ultimately can induce diabetes remission. The Diabetes Remission Outcome Protocol (DROP) used this nutrition intervention for 12 weeks—combined with strength training—followed by 9 months of a low-calorie diet and exercise. Individuals with diabetes for less than five years had remission from diabetes.[2]
In one study, individuals followed a very low-calorie diet as part of a weight management intervention. After one year, almost half of the study participants experienced remission of type 2 diabetes.[3] At 2 years, nearly 1 in 3 remained in remission.[4] Because of this emerging data, very low-calorie diets using meal replacements, including diabetes-specific nutrition formulas, are recommended by diabetes medical societies like Diabetes Canada.[5]
Dietary Changes Can Help Lower Blood Glucose and Manage Diabetes
Keeping blood glucose in check is of the utmost importance when managing type 2 diabetes. Often, ensuring your glucose levels stay within a healthy range requires a multifaced approach of a healthy eating plan and exercise along with potential medication.
Consuming carbohydrates along with protein and fiber can lower the glycemic index of a meal (a measure of how quickly a food causes your blood sugar levels to rise). Fat slows digestion, so foods that contain more fat convert carbs into glucose more slowly. As part of a balanced diet, people with diabetes should increase protein and fiber intake, while reducing carbohydrates (to approximately 500 calories per day), sodium and fats from meat.
The role of Diabetes-Specific Nutritional Formulas
Leading diabetes and nutritional organizations worldwide now recommend the integration of diabetes-specific nutritional formula into diabetes management plans. These formulas are recognized for their potential to help control diabetes effectively, through their use as a meal or snack replacements, as supplemental diets, or sole nutritional source for more severe cases, or as part of a meticulously controlled low calorie diet.
By integrating diabetes-specific nutritional formula into daily dietary plans, individuals living with diabetes can enjoy balanced macronutrient intake and better manage their carbohydrate consumption, thereby empowering them to take control of their condition.
Diabetes is a major health issue and burdens countries around the world – especially developing countries, like the Philippines. There are currently 4.3 million adults, aged 20-75 years living with diabetes[6] and this is expected to rise rapidly by 28% by 2030[7] – making Philippines among the top 10 countries in the world with the highest number of people living with diabetes[8].
How a Diabetes-Specific Nutritional Formula Helps
According to a new pilot study, diabetes specific nutrition as part of a balanced diet shows promise to help improve blood glucose control.
The long-term study on diabetes-specific formula (DSF) compared two distinct treatments on 251 enrolled participants over a 90-day period. The DSF group received 1-2 servings per day of Glucerna as a partial meal replacement alongside the standard of care, while the control group was provided with the standard of care alone.
The study’s findings showed Glucerna’s significant impact on critical health markers in diabetes patients:
- DSF led to a notable reduction in HbA1c levels, which is pivotal since every percentage point drop in HbA1c can diminish the risk of microvascular complications by up to 40%.
- There was a significant decrease in fasting blood glucose levels, underlining DSF’s role in stabilizing daily blood sugar levels.
- DSF was effective in reducing fat mass while preserving fat-free mass, alongside significant reductions in visceral adipose tissue. This points to DSF’s role in promoting a healthier body composition among diabetic patients.
- DSF contributed to a significant reduction in both waist and hip circumferences, metrics closely associated with cardiovascular and metabolic health risks.
- The study reported significant reductions in both systolic and diastolic blood pressure, suggesting DSF’s benefits extend to cardiovascular health.
DSF’s ability to improve glycemic control, reduce body weight, and mitigate cardiometabolic risks can substantially lower healthcare costs and mortality rates for diabetic patients. Furthermore, the study highlights DSF’s potential in increasing GLP-1 secretion and reducing insulin requirements, making it a promising adjunctive therapy in diabetes management.
Recognized as the #1 DSF worldwide and the most recommended brand by healthcare professionals in the U.S., Glucerna offers a scientifically formulated blend of 35 nutrients, including a new and improved carbohydrate system, a unique dual fiber blend, myo-inositol, enhanced micronutrients, and a heart-healthy lipid blend, to provide complete, balanced nutrition.
Personalizing Nutrition Care for Individuals with Diabetes
While very low-calorie diets may work for some individuals, others with diabetes may benefit from personalized medical nutrition therapy to manage their condition.
“Speaking with a healthcare professional can help individuals develop a nutrition plan that is customized to their needs and lifestyle; but nutrition recommendations can be hard to customize to specific cultures or lifestyles,” said Dr. Dimaano. “For this reason, Abbott and an international group of experts developed the transcultural Diabetes Nutrition Algorithm (or tDNA)—a global diabetes nutrition care model that translates nutrition recommendations based on cultural differences in diets and lifestyle to improve diabetes management and outcomes.[9]”
Local experts have started to adapt tDNA in many regions and countries around the world. A clinical trial in Malaysia studied the effect of implementing tDNA in the country and found that a lifestyle intervention program using tDNA helped adults with type 2 diabetes improve health outcomes and body weight.[10]
Nutritional tools like tDNA, along with weight management programs that incorporate lifestyle modifications, can empower healthcare professionals and individuals with type 2 diabetes to successfully manage their condition.
[1] Riddle MC, et al. Diabetes Care. 2021 Aug 30;44(10):2438-2444.
[2] Kibaa K, et al. Diabetes 2023;72(Supplement_1):733-P
[3] Lean ME, et al. Lancet. 2018 Feb 10;391(10120):541-551.
[4] Lean ME, et al. Lancet Diabetes Endocrinol. 2019 May;7(5):344-355.
[5] Jin S, et al. Can J Diabetes. 2022 Dec;46(8):762-774.
[6] International Diabetes Federation. 2023. “The Philippines.” International Diabetes Federation. Retrieved January 3, 2024 (https://idf.org/our-network/regions-and-members/western-pacific/members/the-philippines/).
[7]IDF Diabetes Atlas. 2021. “Philippines Diabetes Report 2000 — 2045.” Diabetesatlas.org. Retrieved January 3, 2024 (https://diabetesatlas.org/data/en/country/157/ph.html).
[8]Lima, G., and et. al. 2022. “Patient Education for People Living with Diabetes in the Philippines: A Scoping Review of Information Needs, Diabetes Knowledge and Effectiveness of Educational Interventions.” Diabetes & Metabolic Syndrome: Clinical Research and Reviews 16(5):102494–94. doi: https://doi.org/10.1016/j.dsx.2022.102494.
[9] Mechanick JI, et al. Curr Diab Rep. 2012 Apr;12(2):180-94.
[10] Chee WSS, et al. BMJ Open Diabetes Res Care. 2017 Sep 26;5(1):e000384