The present study was conducted using a randomised, crossover design. Basic anthropometric measurements and blood pressure were taken using standard protocols during the first visit. The methodology used to measure the glycaemic index (GI) was adopted from that described by Brouns et al. [
10] and was in line with the glycaemic response testing protocol recommended by the FAO/WHO [
11] and the International Standards Organisation [
12]. All participants were asked to attend six test sessions on non-consecutive days: in randomised order three sessions for testing the reference food (i.e. 50 g anhydrous glucose beverage) and another three sessions for testing the oral nutritional supplements. All test beverages were given in portions containing 50 g of available carbohydrates: beverage 1: 370 mL ready-to-drink Isocal, Nestlé Nutrition, Tainan, Taiwan; beverage 2: 427 mL ready-to-drink Diasip, Nutricia Advanced Medical Nutrition, Zoetermeer, The Netherlands; and beverage 3: 534 mL Protinex Diabetes Care powder mixed in milk according to label, Protinex, Mumbai, India. One hundred mL serving of beverage 1 provides 105 kcal, 3.4 g protein, 13.5 g carbohydrate (maltodextrin), and 4.4 g fat; beverage 2 provides 104 kcal, 4.9 g protein, 11.7 g carbohydrate (isomaltulose, starch, and lactose), 3.8 g fat and 2.0 g fibre; beverage 3 provides 98 kcal, 6.5 g protein, 9.4 g carbohydrate (lactose, maltodextrin, and starch), 3.4 g fat, and 1.7 g fibre (with 39 kcal, 3.5 g protein, 5.0 g carbohydrate, 0.1 g fat, and 1.7 g fibre from Protinex Diabetes Care powder). The blood glucose concentration in finger-prick capillary blood samples was measured using the HemoCue
® 201+ RT glucose analyser (HemoCue Ltd, Dronfield, UK). Participants arrived at the laboratory in the morning after a 10-h overnight fast. Following a 10-min rest, two blood samples were obtained 5 min apart for determining baseline blood glucose concentrations. They were then given either the reference food (glucose beverage) or the test beverage to consume. Further blood samples were obtained at 15, 30, 45, 60, 90, and 120 min for blood glucose measurements. Blood glucose measurements were performed by qualified researchers. Participants were asked to warm their hand to increase blood flow before a finger prick. Fingers were not squeezed to extract blood from the fingertips, but were gently massaged in order to minimize plasma dilution. The first two drops of blood were discarded, and the subsequent drop was used for testing.
This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving human subjects were approved by the National Healthcare Group Domain Specific Review Board, Singapore. All participants gave written informed consent. This trial was registered at clinicaltrials.gov as NCT01889628.