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Type 2 Diabetes Better Managed with High-Calorie Breakfast and Low-Calorie Dinner

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Type 2 Diabetes Better Managed with High-Calorie Breakfast and Low-Calorie Dinner
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Breakfast and diabetes riskAccording to a recent study, patients with type 2 diabetes who eat a high-calorie breakfast and a low-calorie dinner have superior blood sugar control compared to those who eat inversely. The researchers suggest correcting diet routines could help optimize metabolic regulation and avert complications in people with type 2 diabetes. The study is published in the journal Diabetologia.

In their study titled “High-energy breakfast with low-energy dinner decreases overall daily hyperglycemia in type 2 diabetic patients: a randomised clinical trial,” Oren Froy from the Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem in Israel and colleagues conducted a randomized controlled trial to test if a breakfast high in energy and a dinner with lower energy (Bdiet) could reduce postprandial hyperglycaemia (PPHG) in patients with type 2 diabetes by increasing incretin and insulin levels in comparison with a high-energy dinner and reduced-energy breakfast (Ddiet).

A total of 22 type 2 diabetes patients were randomized and 18 were evaluated for a week with the two diets. Patients under diet B consumed a 2946 kilojoule (kj) breakfast, 2523 kj lunch, and 858kj dinner. Patients under diet D diet consumed 858 kj breakfast, 2523 kj lunch, and 2946 kj dinner. One larger meal included milk, a granola bar, tuna, scrambled egg, cereal and yogurt and the smaller meal was limited to mozzarella, turkey breast, coffee and salad.

The results revealed that post-meal glucose levels throughout the day were 20% lower and the levels of insulin, C-peptide and GLP-1 were 20% higher in participants on diet B compared with those on diet D. Despite the diets being isoenergetic, lunch resulted in lower glucose (by 21–25%) and higher insulin (by 23%) with the diet B compared to diet D.

Based on these results, the researchers suggest that high energy intake at breakfast is associated with significant reduction in overall PPHG in diabetic patients over the entire day.

“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,” said Professor Froy in a recent news release. “A person’s meal timing schedule may be a crucial factor in the improvement of glucose balance and prevention of complications in type 2 diabetes and lends further support to the role of the circadian system in metabolic regulation.”

Professor Jakubowicz adds: “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. 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.”

She concludes: “High energy intake at breakfast is associated with significant reduction in overall post-meal glucose levels in diabetic patients over the entire day. This dietary adjustment may have a therapeutic advantage for the achievement of optimal metabolic control and may have the potential for being preventive for cardiovascular and other complications of type 2 diabetes.”

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