{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:17:12Z","timestamp":1778685432416,"version":"3.51.4"},"reference-count":86,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In Singapore, only one-quarter of patients with type 2 diabetes mellitus and overweight\/obesity in the primary care setting are achieving clinical targets with a food-first approach to medical nutrition therapy. Diabetes-specific formula as meal replacement (DSF-MR) provides an evidence-based escalation of care but remains underutilised in practice. We developed expert consensus recommendations to support the use of DSF-MR in Singapore and across Asia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multidisciplinary 11-member advisory board guided a multicomponent study that included an online healthcare professional survey, a narrative literature review, and structured consensus development. Survey insights shaped research questions and the narrative review, and collated findings were subsequently discussed at an advisory board meeting. Practical recommendations emerging from the meeting were finalised through two rounds of blinded online voting (&amp;gt;70% agreement) and then consolidated into a clinical algorithm for practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighteen practical, evidence-based recommendations achieved consensus. Collectively, they outline the clinical role of DSF-MR across three key applications: improving glycaemic control, supporting diabetes remission, and preserving muscle mass. Recommendations also address patient selection, integration within holistic care approaches, monitoring, and improving adherence, with the aim of optimising outcomes with DSF-MR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DSF-MR is supported by evidence as a versatile dietary intervention that can be integrated across the diabetes care continuum. These expert consensus recommendations address critical gaps in current practice and provide clear and actionable guidance for the use of DSF-MR in routine diabetes care across primary care and specialist settings in Singapore.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1810277","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:51:40Z","timestamp":1778683900000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetes-specific formula as meal replacement for individuals with type 2 diabetes mellitus and overweight or obesity: a Singapore expert consensus"],"prefix":"10.3389","volume":"13","author":[{"given":"Chin Meng","family":"Khoo","sequence":"first","affiliation":[{"name":"Division of Endocrinology, National University Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Tan","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Care, Farrer Park Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo Kiang","family":"Eng","sequence":"additional","affiliation":[{"name":"Central-North Primary Care Network","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Choon Kit","family":"Leong","sequence":"additional","affiliation":[{"name":"Mission (Hougang) Medical Clinic","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong Mong","family":"Bee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwang Wei","family":"Tham","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Woodlands Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpana","family":"Bhaskaran","sequence":"additional","affiliation":[{"name":"Glycemic Index Research Unit, Temasek Polytechnic","place":["Singapore, Singapore"]},{"name":"Singapore Nutrition and Dietetics Association","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yik Voon","family":"Lee","sequence":"additional","affiliation":[{"name":"Lee & Tan Family Clinic and Surgery","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gladys Hooi Chuan","family":"Wong","sequence":"additional","affiliation":[{"name":"Nutrition & Dietetics, Khoo Teck Puat Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo Ling","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Ng Teng Fong General Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phong Ching","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital","place":["Singapore, Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1515797","DOI":"10.3389\/fpubh.2025.1515797","article-title":"Global, regional, and national burden of type 2 diabetes mellitus caused by high BMI from 1990 to 2021, and forecasts to 2045: analysis from the global burden of disease study 2021","volume":"13","author":"Huang","year":"2025","journal-title":"Front Public Health"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.2337\/db23-1323-P","article-title":"1323-P: Meta-analysis of multiple comorbidities associated with type 2 diabetes","volume":"72","author":"Khachikyan","year":"2023","journal-title":"Diabetes"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"966093","DOI":"10.3389\/fpubh.2022.966093","article-title":"The global burden of type 2 diabetes attributable to high body mass index in 204 countries and territories, 1990-2019: an analysis of the global burden of disease study","volume":"10","author":"Zhang","year":"2022","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.2337\/dc25-SINT","article-title":"Standards of Care in Diabetes\u20142026","volume":"49","year":"2026","journal-title":"Diabetes Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.eprac.2025.07.017","article-title":"American Association of Clinical Endocrinology Consensus Statement: algorithm for the evaluation and treatment of adults with obesity\/adiposity-based chronic disease - 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