Reducing Total Daily Insulin Dose in T2D: 3-Meal vs 6-Meal Diet

In obese people with uncontrolled insulin-treated type 2 diabetes (T2D), a 3-meal diet consisting of high-energy breakfast and lunch but low-energy dinner was more effective than the traditional 6-meal diet evenly distributed throughout the day for weight loss, overall glycemia, hemoglobin A1c (HbA1c) level, appetite, and reduction of insulin requirements, according to an abstract presented at ENDO 2018: The Endocrine Society Annual Meeting, held March 17-20 in Chicago, Illinois.¹

Daniela Jakubowicz, MD, from the Wolfson Medical Center at Tel Aviv University in Israel, and colleagues, randomly assigned 29 people (18 men, 11 women) to 3 months of either a 1600-kcal (±200 kcal) 3-meal diet (breakfast 50%, lunch 33%, dinner 17%) or a 6-meal diet (breakfast 20%, lunch 25%, dinner 25%, plus 3 snacks 10% each) and assessed the effect of diet on body mass index (BMI), HbA1c level, overall glycemia, appetite, and total daily insulin dose. Overall glycemia was assessed for 14 days at baseline and at the end of the intervention by continuous glucose monitoring; total daily insulin dose was titrated biweekly.

Participants were an average 69 years of age with a BMI of 32.2 and had T2D for approximately 20 years. 

After the 3-month intervention, weight loss, BMI, HbA1c level, overall glycemia measured by continuous glucose monitoring, overall visual analog scale 100 hunger scores, craving scores (especially for carbohydrates/starches), and total daily insulin dose were reduced significantly in the 3-meal diet vs 6-meal diet group, respectively, as follows (P <.05 for all):

• Weight loss: -5.0 ± 3.2 kg vs +0.05 ± 1.4 kg
• BMI: -1.9 ± 1.2 kg/m² vs 0.1 ± 1.8 kg/m²
• HbA1c: 1.2 ± 0.8% (from 8.2 ± 1% to 7.0 ± 0.6%) vs -0.2 ± 1% (from 7.9% to 7.7%)
• Overall glycemia: -38 ± 23 mg/dL (from 167 ± 33 to 129 ± 10 mg/dL) vs -17 ± 24 mg/dL (from 171 ± 44 to 154 ± 38 mg/dL)
• Overall visual analog scale 100 hunger scores: -18 ± 3 vs 2 ± 1.7
• Craving scores: -36 ± 7.7 vs 4 ± 5.1
• Total daily insulin dose: -20.5 ± 24.7 units/day (from 54.7 ± 26.8 to 34.8 ± 25.2 units/day) vs 2.2 units/day (from 67.8 ± 47.5 to 70.0 ± 51.1 units/day)  

“This study shows that, in obese insulin-treated patients [with T2D], a diet with 3 meals per day, consisting of a big breakfast, average lunch, and small dinner, had many rapid and positive effects compared to the traditional diet with 6 small meals evenly distributed throughout the day,” said Dr Jakubowicz in a press release.² “A diet with adequate meal timing and frequency has a pivotal role in glucose control and weight loss,” concluded Dr Jakubowicz.

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References

1. Jakubowicz D, Froy O, Tsameret S, et al. High energy breakfast diet is an effective strategy for weight loss and reduction of the total daily insulin dose in type 2 diabetes. Presented at: ENDO 2018: The Endocrine Society Annual Meeting; Chicago, IL; March 17-20, 2018. Abstract OR05-2.
2. A high-energy breakfast promotes weight loss and helps reduce total daily insulin dose in type 2 diabetes [press release]. Washington, DC: Endocrine Society. Published March 18, 2018. Accessed March 18, 2018.