Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: a randomised clinical trial

Br J Nutr. 2014 Aug 28;112(4):504-12. doi: 10.1017/S0007114514001123.


Low-glycaemic index diets reduce glycated Hb (HbA1c) in patients with type 2 diabetes, but require intensive dietary support. Using a liquid meal replacement with a low glycaemic response (GR) may be an alternative dietary approach. In the present study, we investigated whether breakfast replacement with a low-GR liquid meal would reduce postprandial glycaemia and/or improve long-term glycaemia. In the present randomised, controlled, cross-over design, twenty patients with type 2 diabetes consumed either a breakfast replacement consisting of an isoenergetic amount of Glucerna SR or a free-choice breakfast for 3 months. Postprandial AUC levels were measured using continuous glucose measurement at home. After the 3-month dietary period, meal profiles and oral glucose tolerance were assessed in the clinical setting. The low-GR liquid meal replacement reduced the AUC of postprandial glucose excursions at home compared with a free-choice control breakfast (estimated marginal mean 141 (95 % CI 114, 174) v. estimated marginal mean 259 (95 % CI 211, 318) mmol × min/l; P= 0·0002). The low-GR liquid meal replacement also reduced glucose AUC levels in the clinical setting compared with an isoenergetic control breakfast (low GR: median 97 (interquartile range (IQR) 60-188) mmol × min/l; control: median 253 (IQR 162-386) mmol × min/l; P< 0·001). However, the 3-month low-GR liquid meal replacement did not affect fasting plasma glucose, HbA1c or lipid levels, and even slightly reduced oral glucose tolerance. In conclusion, the low-GR liquid meal replacement is a potential dietary approach to reduce postprandial glycaemia in patients with type 2 diabetes. However, clinical trials into the effects of replacing multiple meals on long-term glycaemia in poorly controlled patients are required before a low-GR liquid meal replacement can be adopted as a dietary approach to the treatment of type 2 diabetes.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Beverages* / adverse effects
  • Breakfast*
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cross-Over Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diet therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diet, Diabetic / adverse effects
  • Diet, Diabetic / methods*
  • Dietary Carbohydrates / adverse effects
  • Dietary Carbohydrates / therapeutic use
  • Dietary Fats, Unsaturated / adverse effects
  • Dietary Fats, Unsaturated / therapeutic use
  • Female
  • Food, Formulated* / adverse effects
  • Glucose Intolerance / prevention & control
  • Glucose Tolerance Test
  • Glycated Hemoglobin / analysis
  • Glycemic Index*
  • Humans
  • Hyperglycemia / prevention & control*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Patient Dropouts
  • Postprandial Period
  • Risk Factors


  • Dietary Carbohydrates
  • Dietary Fats, Unsaturated
  • Glucerna
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human