For patients with type 2 diabetes, consuming a high-energy breakfast and reduced-energy dinner led to better blood glucose control when compared with those who ate a high-energy dinner and reduced-energy breakfast, results of a small study published in Diabetologia indicate.

“These observations suggest that a change in meal timing influences the overall daily rhythm of post-meal insulin and incretin and results in a substantial reduction in the daily post-meal glucose levels,” study co-author Oren Froy, PhD, of the Hebrew University of Jerusalem, said in a press release.

The randomized, open label, crossover study enrolled 22 patients with type 2 diabetes of less than 10 years duration. Patient age ranged from 30 to 70 years; BMI ranged from 22 to 35; and HbA1c ranged from 7% to 9%. All were also being treated with metformin and/or diet.

A total of 18 completed the study and were included in the analysis.

The researchers randomly assigned patients to a diet that included a high-energy breakfast and a reduced-energy dinner (Bdiet) or a diet that included a reduced-energy breakfast and a high-energy dinner (Ddiet) for 7 days. The Bdiet was comprised of a 2,946-kJ breakfast, a 2,523-kJ lunch and an 858-kJ dinner, whereas the Ddiet involved an 858-kJ breakfast, a 2,523-kJ lunch and a 2,946-kJ dinner.

Postprandial levels of plasma glucose, insulin, C-peptide and intact and total glucagon-like peptide-1 (iGLP-1 and tGLP-1, respectively) were evaluated.

According to results, during the day, the area under the curve (AUC) for glucose among patients on the Bdiet was 20% lower, whereas levels of insulin, C-peptide and tGLP-1 levels were 20% higher when compared with the Ddiet group.

Three hours after eating, the AUC peak for glucose was 24% lower and insulin AUC 11% higher with the Bdiet. Also higher in the Bdiet group at this time were levels of tGLP-1 (+30%) and iGLP-1 (+16%).

In addition, despite lunches containing the same total energy and calories in both groups, lunch in the Bdiet group resulted in lower glucose by 21% to 25% and higher insulin by 23%.

Study co-author Daniela Jakubowicz, MD, of Tel Aviv University in Israel, offered insight into these findings.

“The mechanism of better glucose tolerance after high-energy breakfast than after an identical dinner may be in part the result of clock regulation that triggers higher beta cell responsiveness and insulin secretion in the morning, and both a lower rate of breakdown of insulin by the liver and the increase in insulin-mediated muscle glucose uptake in the morning,” she said in the release.

“Thus, recommending a higher energy load at breakfast, when beta cell responsiveness and insulin-mediated muscle glucose uptake are at optimal levels, seems an adequate strategy to decrease post-meal glucose spikes in patients with type 2 diabetes.”

Reference

  1. Jakubowicz D et al. Diabetologia. 2015;doi:10.1007/s00125-015-3524-9.