February 25, 2015
2 min read

High-energy breakfast improves all-day glucose control in patients with type 2 diabetes

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Adults with type 2 diabetes achieved better blood glucose control with a high-energy breakfast and low-energy dinner than a low-energy breakfast and high-energy dinner, according to research published in Diabetologia.

By making the dietary adjustment, patients could optimize their metabolic control and potentially prevent cardiovascular and other disease-related complications, according to researchers.

“It is known that glucose metabolism and glucose peaks after meals are controlled by circadian clock genes, displaying diurnal variation or circadian rhythms, with larger glucose peaks after identical meals in the evening and smaller blood glucose elevation than in the morning,” Daniela Jakubowicz, MD, of Wolfson Medical Center, Tel Aviv University, told Endocrine Today. “Just by changing the time of the high-caloric meal, we may achieve significant reduction in glucose peaks throughout the day.”

Daniela Jakubowicz

Daniela Jakubowicz

Jakubowicz and colleagues tested the meal schedules in a randomized, open-label, crossover study involving 18 adults (eight men, 10 women; BMI, 22-35 kg/m2) aged 30 to 70 years who had type 2 diabetes for less than 10 years.

Patients were treated with diet (n = 8) or diet and metformin (n = 10) for 1 week. The two diets — high-energy breakfast and low-energy dinner (Bdiet: 2,946 kJ breakfast, 2,523 kJ lunch and 858 kJ dinner) and high-energy dinner and reduced-energy breakfast (Ddiet: 858 kJ breakfast, 2,523 kJ lunch and 2,946 kJ dinner) — contained the same total energy but were arranged differently.

On the final day, patients consumed their meal in a clinic setting for sampling. The investigators assessed postprandial levels of plasma glucose, insulin, C-peptide and intact and total glucagon-like peptide-1. Patients changed diets 2 weeks later, and the researchers repeated the tests.

Compared with the Ddiet, the area under the curve (AUC) for glucose during the day was 20% lower, and the AUC for insulin, C-peptide and total GLP-1 was 20% higher with the Bdiet.

Glucose AUC from 0 to 180 minutes and its peak were both lower by 24%, whereas insulin AUC from 0 to 180 minutes was 11% higher with the Bdiet vs. Ddiet; further, the Bdiet was accompanied by 16% higher intact GLP-1 levels and 30% higher total GLP-1 levels.

Although the diets contained the same energy, lunch resulted in lower glucose (by 21%-25%) and higher insulin (by 23%) with the Bdiet compared with the Ddiet.

“Very often, patients with type 2 diabetes have meal timing non-aligned with the circadian rhythms,” Jakubowicz said. “They frequently skip breakfast while eating high calorie dinner. This meal timing schedule is associated with obesity, higher HbA1C and poor glycemic control.”

The findings demonstrate patients can reap benefits from the calorie-shift and offer an alternative that should be considered as a therapeutic strategy in patients with type 2 diabetes.

“It is not enough to recommend what a patient should or should not eat,” Jakubowicz said. “Rather, it is important to emphasize the more adequate meal timing pattern and distribution of daily calories that should be followed to improve glycemic control throughout the day.” – by Allegra Tiver

For more information:

Daniela Jakubowicz, MD, can be reached at the Diabetes Unit, E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Israel.

Disclosure: The researchers report no relevant financial disclosures.