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...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 (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 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.展开更多
Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the li...Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.展开更多
文摘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 (AUC0-240 min) by 65% to 82% compared to the STD formulation (p < 0.001). GTSN also elicited ~50% lower insulin positive AUC0-240 min (p < 0.05), while postprandial GLP-1 responses were increased (p = 0.018) vs. STD. In the CHO Type Study, glucose positive AUC0-240 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.
文摘Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.
