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Bigger breakfast and smaller dinner may help diabetes control

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Eating a combination of a high energy breakfast and a low energy dinner helps control blood glucose in patients with type 2 diabetes, according to a small study by Israeli researchers.

Adjusting diet in this fashion could help optimise metabolic control and prevent complications of type 2 diabetes, suggest the study authors in the journal Diabetologia.

The study included 18 diabetes patients, aged 30-70, with a body mass index of 22-35 kg/m2, who were treated with metformin and/or dietary advice. They were randomised to one of two diets for one week. 

One diet contained 2,946 kilojoule (kj) breakfast, 2,523kj lunch, and 858kj dinner, while the other contained the same total energy but arranged differently, with a 858kj breakfast, 2,523kj lunch, and 2,946kj dinner.

The larger of the two meals included milk, tuna, a granola bar, scrambled egg, yoghurt and cereal, while the smaller meal contained sliced turkey breast, mozzarella, salad and coffee.

Breakfast was taken at 8am, lunch at 1pm, and dinner at 7pm. Patients consumed their diets at home for six days and for one day at a clinic where a series of blood samples were taken.

Post-meal levels of glucose were measured in each participant, as well as levels of insulin, c-peptide, and glucagon-like-peptide 1 hormone – also known as incretin.

“Recommending a higher energy load at breakfast… seems an adequate strategy to decrease post-meal glucose spikes in patients with type 2 diabetes.”

Daniela Jakubowicz

The results showed that post-meal glucose levels were 20% lower and levels of insulin, C-peptide and incretin were 20% higher in participants on the first diet compared with the second diet. Lunch in the first diet resulted in lower blood glucose (by 21–25%) and higher insulin (by 23%) compared with the lunch in the second diet.

Study author Professor Oren Froy, from the Hebrew University of Jerusalem, said: “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.”

“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,” he said.

Fellow researcher Professor Daniela Jakubowicz, from Tel Aviv University, added: “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.”


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