Macronutrient content is “unimportant” in Type 2 diabetes formula meal replacements, suggests analysis

18 Nov 2021 --- Low energy diets with formula meal replacements are the most effective methods of weight management and remission in adults with Type 2 diabetes (T2D), according to a new study from the UK and New Zealand.

However, macronutrient content (carbohydrates, proteins and fats) is not essential to achieving these outcomes, they say.

Professor Mike Lean, Dr. Chaitong Churuangsuk and colleagues at the University of Glasgow state that “very low-energy diets and formula meal replacement appear to be the most effective approaches as they generally provide less energy than self-administered food-based diets.”

The analysis also found that “Mediterranean, high monounsaturated fatty acid, vegetarian and low-glycaemic-index diets all achieved minimal (0.3 kg to 2 kg) or no difference from conventional relatively low fat or high carb control diets.”

“The evidence, albeit of variable quality, is rather consistent showing that no one diet type is superior over others for weight management in TD2.”

Formula meal replacements
In their analysis of world publications of diet trials for weight management of individuals with TD2, the researchers found that formula meal replacements were superior to food-based low-energy diets alone, achieving 2.4 kg greater weight loss over 12 to 52 weeks.

For remission of T2D, there are no direct comparisons between diet types. Still, published studies showed the best remission rates of 46% to 61% at 12 months with programs that include a formula “Total Diet Replacement” of 830 kcal per day for 12 weeks, followed by a relatively low-fat high carbohydrate diet and meal replacements for long-term maintenance.Weight loss is critical to the management and remission of T2D and can reduce patients’ need for medication.

With low carbohydrate diets, reported remission rates are much lower at 4% to 19% of those who tried the diet.

Weight management key for TD2
According to researchers, the global epidemic of TD2 is driven by the rising number of overweight and obese populations. The researchers note: “Without strategic commitment internationally on effective prevention strategies, TD2 will affect an estimated 629 million people worldwide by 2045.”

Echoing the need for prevention due to an increasing number of people with diabetes, Diabetes UK previously called for government intervention to combat diabetes.

The research team also suggests that “well-conducted research is needed to assess longer-term impacts on weight, blood sugar control, clinical outcomes and diabetes complications.”

Both genetic and environmental factors influence the development of TD2. However, weight gain also plays a vital role. When individuals get TD2, there is an interaction of gut hormones, low-grade inflammation and possibly metabolites from the gut microbiota.There is no one type of diet that is superior over others for weight management in people with TD2.

Analysis of world publications
The study authors flag that “ill-informed controversy” over diet types has contributed to inaction and delays in providing effective treatment.

Current guidelines stress the importance of personalized weight management and state that various diet strategies may be effective but not provide information about diet composition. This can lead to patients following diets based on distorted evidence and misleading claims.

The researchers wanted to help resolve these uncertainties and inform clinical decision-making and guideline development as part of a program of work to update the recommendations of the European Association for the Study of Diabetes.

Following World Diabetes Day, industry experts told NutritionInsight that “healthy food, nutrition education and care” may help reduce the impact of the disease.

By Nicole Kerr