Discussion
satiety, postprandial gastrointestinal hormones, MFDM, diabetes
TYPE 2 DIABETES, DIABETES
In the first study, we demonstrated that the novel rice-based MFDM powder formula had attenuated postprandial glycemic response compared with glucose in a healthy population, resulting in a low GI and a low-to-intermediate GL. In the second study performed in adults with diabetes or at risk for diabetes, when compared with the commercially available standard formula (SF), the MFDM powder formula had significantly lower postprandial glycemic and insulin responses even when the serving sizes were matched for the carbohydrate content and macronutrient distribution (We also demonstrated in the second study that the MFDM powder formula had similar glucose and insulin responses when compared with a commercially available diabetes-specific formula (DSF) in adults at risk for or diagnosed with early diabetes. The carbohydrate sources differed significantly between the two formulas. Commercial product 2 contained maltodextrin (40%), Fibersol 2 (25%), and sucromalt (20%), while the MFDM powder formula contained physically modified rice flour (22.3%), fructose (11.5%), and isomaltulose (15.6%) (In Study 2 we showed that the novel MFDM powder formula produced suppressed hunger and maintained satiety throughout the course of each intervention day. The formula also stimulated the release of active GLP-1, GIP, and PYY, and suppressed active ghrelin over the course of 180 minutes. However, such effects on hunger, satiety and postprandial gastrointestinal hormones did not differ significantly from the commercially available SF and DSF. Some previous studies demonstrated the ability of diabetes-specific formulas to stimulate greater postprandial GLP-1 release compared with control foods or standard formulas (The limitations of our studies included a short-term study design. Although we were able to assess postprandial glycemic and hormonal responses after consumption of the novel rice-based MFDM powder formula, long-term studies are required to investigate the effects of the MFDM formula on glycemic control, body weight, and other health outcomes over a longer period. The generalizability of our study may also be limited as the study was single-center and enrolled only healthy individuals, those at risk for diabetes, and those with early-onset type 2 diabetes. The effects of the MFDM powder on people with long-standing diabetes must be assessed in another study. The strengths of our studies, primarily Study 2, included a double-blinded multi-arm randomized crossover design, and matching of macronutrient distribution and carbohydrate content per serving in the three formulas tested.To conclude, we showed in this study that in healthy participants, the rice-based MFDM powder formula had a low glycemic index and a low-to-intermediate glycemic load. We also showed that in adults at risk for diabetes or with early type 2 diabetes, the MFDM powder formula produced significantly less glucose and insulin responses compared with a commercially available standard formula (SF). The MFDM powder formula may be an option for patients who require diabetes-specific formulas, particularly those who are vegan as all of its ingredients are plant-based. The use of locally sourced ingredients has lowered the cost of the MFDM to 18-24 THB (0.5-0.7 USD) per 250 ml serving compared with 70-170 THB (2-5 USD) per 250 ml serving for other commercial formulas. This likely would improve patient access and reduce the barrier to care in resource-limited settings such as in Thailand.