The Effects Of Low-GI Meal Replacement On Management Of Diabetes And Impaired Glucose Regulation

With the rapid economic development, the dialy diet and lifestyle was changed, as a result, China has become the second largest country, according to the prevalence of diabetes, just following India. Long-term of high blood glucose and associated risk factors can cause sericous complications, which can affect the health and quality of life, even is life-threatening. Impaired glucose regulation (IGR) is an intermediate stage of the process of diabetes. The prevalence rate of the diabetes in the IGR group is more than three times higher in the healthy group. In Shanghai, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) prevalence rates were 6.9% and 1.0% in 2006.The quantity and variety of staple foods can directly affect the dietary balance and health. The reduction of grain intake and the change from the crude cereal to refined cereals in recent years were the major changes in diet pattern, and also an important factor in diabetic prevalence increasing year by year. Scientific and positive nutritional interventions were helpful to control diabetes.Low GI diet is the nutritional prevention of chronic diseases in recent years, research on a new hot spot. The core of this theory is that the different foods with the same amount of carbohydrate, their digestion and absorption rate, and blood sugar level is not the same. Foods with low GI release glucose slowly, so the peak of postprandial blood glucose and levels of insulin were lower, and peripheral tissue glucose uptake rate increase. It's helpful to control the blood sugar and reduce the insulin resistance.Meal replacement (MR) is to prepare a kind of healthy diet, which meets particular nutritional requirements, and then replace directly part or all of the self-selection food with it. In recent years, studies have shown that Meal replacement is economic and security, and can avoid mistakes between the theory and practice in the conventional dietary intervention.This study has combined the low GI theory and meal replacement theory in the interventions. Patients with diabetes or impaired glucose regulation in the community were received intervention, including diabetes education with frequent blood glucose monitoring, nutritional counseling, exercise guidance, and particularly nutritional meal replacement were supplied as the breakfast. With theses intervention, we study the effect of low GI diets on diabetes and IGR.Object1,To measure the glycemic index and the composition of meal replacement, which mainly contains soy bean, oat and so on.2,Observe the impression of meal replacement on 2hPG (2-hour postprandial plasma glucose) in patients with DM, and comprehend its security and tolerance。3,Study the effects of low GI meal replacement in sujects with type 2 diabetes or IGR on glucose and lipid metabolism,weight control and the oxidative stress, to provide a basis for further the use of low-GI meal replacement in diabetes preventing.Methods1,With 50g glucose as reference, the 7 points of blood glucose were measured after taking meal replacement following international current method. Then the AUC and GI of meal replacement was calculated by Wolever's method, and also its composition and related health indicators were detected.2,10 subjects with diabetes participated in the study. The different effects on postprandial blood glucose were observed after taking 200Kcal meal replacement or the traditional diet.3,128 subjects with type 2 diabetes (T2DM) and 94 subjects with impaired glucose regulation (IGR) in communities were randomized into a-3month, randomized clinical intervention trial. The control group received general diabetes education and the intervention group received intensive intervention, particularly low GI meal replacement as the breakfast. And subjects were measured including fasting blood glucose and oral glucose tolerance test (OGTT) 2h blood glucose, glycated hemoglobin (HbA1C), blood lipids, liver and kidney function, waist and hip circumference and body weight, antioxidant index, to observe the effects of low GI meal replacement.Results1,The GI of meal replacement was 42.13, and in per100g of meal replacement, the energy was 1900KJ, which contained 21.8g protein,15.2g fat,55.8g carbohydrates and 12.2 fiber.2,After taking meal replacement, the PBG2h was 6.45mmol/L, and decreased 28.0%～31.9% compared to the traditional meal(P<0.05).3,After low-GI meal replacement intervention,in DM intervention group, OGTT2hPG decreased 24%(13.55±2.97mmol/L vs 10.58±3.44mmol/L, P<0.01); subjects with high FPG level(≥7.0mmol/L), the FPG levels decreased significantly after intervention (7.96±0.70mmol/L vs 6.75±0.85mmol/L, P<0.01); HbA1C was also significantly improved if the baseline was≥6.3%(-0.34±0.09%, P<0.01); insulin resistance(HOMA-IR) in intervention group also significantly decreased (3.37±3.22 vs 1.91±1.06, P<0.01). The TC, TG level in intervention group showed a downward trend, but without statistical significance (P>0.05) In Intervention group the body weight decreased by 1.4kg, waist circumference reduced 3.6cm, the difference was significant (P<0.01), and mainly showed body fat and visceral fat reduction(P<0.01). In the overweight/obese subjects, it can be observed that body weight decreased by 1.88kg,1.48kg, waist circumference decreased by 4.26cm, 5.77cm (P<0.01). The antioxidant levels in the intervention group (AOR) improved significantly, and glutathione (GSH),superoxide dismutase (SOD) significantly increased with malondialdehyde (MDA) decreased significantly (P<0.01). In control group the body weight decreased by 1.3kg, waist circumference reduced 2.2cm, and no significant difference were obsevred in glycolipids metabolism and antioxidant levels(P> 0.05).5,After low-GI meal replacement intervention, in IGR intervention group, OGTT2hPG decreased 10.7%(8.88±1.27mmol/L vs 7.93±1.72mmol/L, P<0.01), the average weight loss was 1.6kg and the waist circumference decreased 3.9cm(P <0.01), visceral fat was also significantly decreased (P<0.01). It also observed that GSH and SOD significantly increased (P<0.01) and antioxidant levels increased in intervention group. In control group no significant difference were obsevred in glycemic metabolism and weight loss(P> 0.05); and the waist circumference decreased 2.2cm (P<0.01), and superoxide dismutase (SOD) significantly decreased (P<0.05)Conclusions1,The mixed whole grain powder was a kind of low-GI nutritional food rich in dietary fiber.2,Compared to the traditional meal, mixed whole grain power can effectively reduce postprandial plasma glucose levels in diabetic patients.3,Low-GI meal replacement can reduce fasting glucose levels, improve glucose tolerance,it was more effective especially for these with higher basis of blood glucose in diabetes. For patients with high levels of HbA1c, it also can improve it. Low-GI meal replacement can also reduce insulin resistance. It was also effective to improve lipid metabolism, control weight, reduce body weight and waist circumference in the overweight/obese patients, and mainly reduce body fat and visceral fat. Low-GI meal replacement can improve the antioxidant levels in patients with DM.4,Low-GI meal replacement can improve glucose tolerance in patients with IGR and reduce insulin resistance, improve lipid metabolism, reduce weight and waist circumference, and can reduce visceral fat area. Low-GI meal replacement also can improve the levels of GSH and SOD in IGR patients.5,low-GI meal replacement can be used as an effective nutritional intervention of managing diabetes and impaired glucose regulation.