A high-energy-type oral dietary supplement (ONS), with a low proportion of available carbohydrate (LC-ONS), which contains a slowly digestible carbohydrate, isomaltulose, and is fortified with soluble dietary fiber, was newly developed for individuals with diabetes or prediabetes. This study aimed to evaluate the impact of LC-ONS on blood glucose levels after ingestion in individuals with prediabetes. A single-blind, randomized crossover clinical trial was performed on 20 individuals with prediabetes. After overnight fasting, all subjects ingested one serving (200 kcal/125 mL) of either LC-ONS (40% energy proportion of available carbohydrates) or standard ONS (ST-ONS, 54% energy proportion of available carbohydrates) on two separate days. The incremental area under the curve of blood glucose levels for 120 min was significantly lower after LC-ONS ingestion compared to ST-ONS (2207 ± 391 mg/dL·min (least mean square value ± standard error) and 3735 ± 391 mg/dL·min, respectively; p < 0.001). The LC-ONS showed significantly lower blood glucose levels than the ST-ONS at all time points, except at baseline. Similarly, the incremental area under the curve of plasma insulin was significantly lower after LC-ONS ingestion. These results suggest that LC-ONS is useful as an ONS for energy supply in individuals with postprandial hyperglycemia.

Background: Older people are more susceptible to deterioration of the gut microbiota. Prebiotics help improve the gut microbiota. Inulin, a major prebiotic, stimulates the growth of Bifidobacterium; however, it produces a large amount of gas, which leads to abdominal symptoms. Methods: In this study, in vitro fecal fermentation was performed using fecal samples from seven older people (mean subject age, 73.4 years; five men and two women) to examine whether combining inulin with another prebiotic material, resistant dextrin, could lead to decreased gas production and show prebiotic effects. Results: The Bifidobacterium counts and short-chain fatty acid production did not differ significantly between the inulin 0.5% group and the inulin 0.25% plus resistant dextrin 0.25% combination group. However, the inulin 0.25% plus resistant dextrin 0.25% combination group had lower gas production than the inulin 0.5% group (p < 0.10). Furthermore, compared with the inulin 0.5% group, the 0.25% combination group showed significantly greater gut microbiota diversity and tended toward a lower pH in the fermentation medium at the end of fermentation (p = 0.09). These effects are believed to be due to the combination of inulin, which is highly selective for Bifidobacterium and rapidly utilized by the gut microbiota, and resistant dextrin, which is slowly utilized by various bacterial genera. Conclusions: These findings suggest that the inulin plus resistant dextrin combination has superior prebiotic effects in older people and causes less gas production than inulin alone.

Slowly digestible carbohydrates are needed for nutritional support in diabetic patients with malnutrition. They are a good source of energy and have the advantage that their consumption produces a low postprandial peak in blood glucose levels because they are slowly and completely digested in the small intestine. A high-amount isomaltomegalosaccharide containing carbohydrate (H-IMS), made from starch by dextrin dextranase, is a mixture of glucose polymers which has a continuous linear structure of α-1,6-glucosidic bonds and a small number of α-1,4-glucosidic bonds at the reducing ends. It has a broad degree of polymerization (DP) distribution with glucans of DP 10-30 as the major component. In our previous study, H-IMS has been shown to exhibit slow digestibility in vitro and not to raise postprandial blood glucose to such levels as that raised by dextrin in vivo. This marks it out as a potentially useful slowly digestible carbohydrate, and this study aimed to evaluate its in vivo digestibility. The amount of breath hydrogen emitted following oral administration of H-IMS was measured to determine whether any indigestible fraction passed through to and was fermented in the large intestine. Total carbohydrate in the feces was also measured. H-IMS, like glucose and dextrin, did not result in breath hydrogen excretion. Carbohydrate excretion with dietary H-IMS was no different from that of glucose or water. These results show that the H-IMS is completely digested and absorbed in the small intestine, indicating its potential as a slowly digestible carbohydrate in the diet of diabetic patients.