Take the Guesswork Out: Meal Replacement Study Results Can Help PAs Advise Patients with Type 2 Diabetes

Study finds use of diabetes-specific nutrition shakes to replace breakfast and as an afternoon or evening snack improves glycemic response

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October 2, 2020

Meal planning is critical for patients with type 2 diabetes and PAs may find it challenging to provide recommendations to help patients manage blood sugar levels. A new study provides evidence that may help PAs advise their patients about sensible options for diabetes-specific meal and snack replacement.

According to Allyson Hamacher, PA-C, at Mayo Clinic in Phoenix, Arizona, and one of the current faculty advisors for the PA Foundation’s Nutrition Outreach Fellows, meal planning is incredibly important for people who have type 2 diabetes.

Meal planning can lead to healthy meal choices
“Patients who have or are at risk for type 2 diabetes can improve their glycemic control with diet and weight loss. Meal planning can assist patients in having the right mix of carbohydrate, proteins, and fat, in proper portion sizes, which can promote weight loss. Prepared meals and snacks help reduce impulse food purchases and reliance on less healthy convenience food options. In addition, meal planning is a great way to get the entire family actively engaged in healthy meal choices, from making a grocery list, to shopping, to food preparation. When a patient has a strong support system, they can be more successful sustaining healthy habits long term.”

Among the challenges patients with type 2 diabetes face in meal planning, Hamacher says, is knowing where to start, concerns about cost, and how it will affect their families. “I suggest to patients that they follow the plate method, where half of their plate comes from non-starchy vegetables, one quarter from lean proteins, and one quarter from carbohydrates (high fiber and whole grains are best). This is a healthy eating plan that’s good for the entire family, so they can feel comfortable helping their family make some healthy changes as well. Meal planning can also be financially sensible. If patients really need more help with meal planning, refer them to a dietitian or certified diabetes educator to help them make changes to their diet that will provide even further improvements.”

New study offers evidence of oral nutritional supplement effectiveness
There is new data for PAs like Hamacher who treat patients with type 2 diabetes. A recent clinical study in BMJ Open Diabetes Research & Care on diabetes-specific nutrition shakes provides new evidence among everyday people living with diabetes. The pilot study from Abbott followed patients who remained on their typical or real-life diet and were asked to replace their usual breakfast and one afternoon or nighttime snack with diabetes-specific nutrition shakes. Among other results, the study demonstrates that small daily dietary changes like this can have a significant impact on glycemic response after meals.

The study found that the use of diabetes-specific nutrition shakes to replace breakfast and as an afternoon or evening snack improves glycemic response.

“The study compared glycemic response via continuous glucose monitoring with patients on oral medications who self-selected meals/snack vs replacing breakfast and a snack with a diabetes specific supplement,” Hamacher says. “Both patients in the self-selected diet group and those consuming the supplement showed improvement in postprandial glucose response; however, improvement was greater in the supplement group.

“In addition, patients who have trouble making appropriate changes or prefer a prepackaged option can actually improve their postprandial glucose response with an appropriate meal-replacement supplement. Patients also reported subjective improvement in their confidence choosing foods for diabetes management if they replaced breakfast and afternoon snack with a diabetes-specific supplements.”

Those patients who have a tough time with blood sugar levels (glycemic control), Hamacher says, need to check their blood glucose regularly and to measure portion sizes.

Premeasured meals or snacks take the guesswork out
“Patients typically can’t tell when their glucose levels are elevated without objective data. Having specific information about how a meal affects their glucose levels can help them make adjustments based on their responses to food. While I always recommend whole foods to patients, some people may find that they prefer meal or snack-replacement shakes as part of their overall diet plan.”

The study shows that drinking a diabetes-specific nutrition shake was associated with a 47% reduction in post-meal peak glucose after breakfast, compared to not using one. Additionally, this study indicated some interesting trends around reduced nighttime glycemic variability (blood glucose fluctuations/gaps between highs and lows), but more investigation is needed.

Diabetes-specific nutrition can be beneficial – especially for people struggling—because convenient, portion-controlled, diabetes-friendly nutrition helps take the guesswork out.

Although the study had a small sample size, Hamacher concludes, it provides some insights that can help PAs assist their patients with diabetes in making healthier choices and provides some suggestions for future research.

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