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High-energy breakfast has a positive effect on diabetics

In patients with obesity and type 2 diabetes, a meal schedule that includes a high-energy breakfast promotes weight loss, improves diabetes and decreases the need for insulin, new research from Israel reports. The study results were presented at ENDO 2018, the 100th annual meeting of the Endocrine Society.

"This study shows that, in obese insulin-treated type 2 diabetes patients, a diet with three 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 six small meals evenly distributed throughout the day: better weight loss, less hunger and better diabetes control while using less insulin," said lead study author Dr Daniela Jakubowicz, professor of medicine at the Wolfson Medical Centre, Tel Aviv University.

"The hour of the day – when you eat and how frequently you eat – is more important than what you eat and how many calories you eat," she noted. "Our body metabolism changes throughout the day. A slice of bread consumed at breakfast leads to a lower glucose response and is less fattening than an identical slice of bread consumed in the evening."

Jakubowicz and her colleagues studied 11 women and 18 men who had obesity and type 2 diabetes, being treated with insulin and averaged 69 years of age. The patients were randomly assigned to consume one of two different weight-loss diets, which contained an equal number of daily calories, for three months. One group (Bdiet) ate three meals: a large breakfast, a medium-sized lunch and a small dinner. The second group (6Mdiet) ate the traditional diet for diabetes and weight loss: six small meals evenly spaced throughout the day, including three snacks.

Overall glucose levels and glucose spikes were measured for 14 days at baseline, during the first two weeks on diet, and at the end of the study by continuous glucose monitoring (CGM). Glucose levels were tested every two weeks and insulin dosage was adjusted as needed.

At three months, while the Bdiet group lost 5kg (11 pounds) the 6Mdiet group gained 1.4kg (3 lb).

Fasting glucose levels decreased 54 mg/dl (from 161 to 107) in the Bdiet group but only 23 mg/dl (from 164 to 141) in the 6Mdiet group. Overall mean glucose levels dropped in the first 14 days by 29 mg/dl (from 167 to 138 mg/dl) and 38 mg/dl (from 167 to 129 mg/dl) after three months in the Bdiet group. Overall mean glucose levels dropped only 9 mg/dl (from 171 to 162 mg/dl) in the first 14 days and only 17 mg/dl (from 171 to 154 mg/dl) in the 6Mdiet group.

Mean glucose levels during sleep dropped only in the Bdiet group, by 24 mg/dl (from 131 to 107), but not in the 6Mdiet group.

The Bdiet group needed significantly less insulin (-20.5 units/day, from 54.7 to 34.8) while the 6Mdiet group needed more insulin (+2.2 units/day, from 67.8 to 70).

Carbohydrate craving and hunger decreased significantly in Bdiet group but increased in the 6Mdiet group.

Importantly, the researchers found a significant reduction of overall glycaemia after as little as 14 days on Bdiet, when the participant had almost the same weight as at baseline. This finding suggests that even before weight loss, the change in the meal timing itself has a quick beneficial effect on glucose balance that is further improved by the important weight loss found in the 3M diet.

"A diet with adequate meal timing and frequency has a pivotal role in glucose control and weight loss," Jakubowicz observed.

The Ministry of Health of Israel supported the study.

Background: Obese patients with uncontrolled type 2 diabetes (T2D), often require high total daily insulin dose (TDID), which leads to weight gain and further increase of TDID leading to persistent hyperglycemia, a vicious cycle ever-increasing TDID, and a high risk for diabetes complications. We have previously shown that a 3-meal diet with timing schedule, consisting of high energy breakfast and low-energy dinner (Bdiet), can improve glycemic control, reduce appetite and promote weight loss (WL) in obese and orally treated patients with T2D.
Objective: Our aim was to compare the effects of a 3-meal diet with high-energy breakfast (B) and lunch (L) but low-energy dinner (D) (Bdiet) vs. a 6-meal diet evenly distributed along the day (6Mdiet) on weight loss, overall glycemia, appetite and TDID in uncontrolled insulin treated T2D.
Methods: Twenty-nine patients (18M, 11F) aged 69 ± 7.2 yrs, BMI: 32.2 ± 5.1 kg/m2, who have had T2D for 19.9 ± 8.2 yrs, were randomly assigned to 3 month of either Bdiet (1600 ± 200 kcal, B:L:D: 50:33:17%) or 6Mdiet (1600 ± 200 kcal, B:L:D: 20:25:25% + 3 snacks 10% each). Overall glycemia was assessed for 14 days at baseline and at the end of the intervention by continuous glucose monitoring (CGM) and the TDID was titrated biweekly.
Results: After 12 weeks intervention, weight loss in the Bdiet was -5.0 ± 3.2 kg vs +0.05 ± 1.4 kg in the 6Mdiet (p<0.05). BMI decreased by -1.9 ± 1.2 kg/m2 in Bdiet but increased by 0.1 ±1.8 kg/m2 in 6Mdiet (p<0.05). HbA1c decreased by 1.2 ± 0.8% (from 8.2 ± 1% to 7.0 ± 0.6%) in the Bdiet vs. only -0.2 ± 1% in the 6Mdiet (from 7.9% to 7.7% (p<0.05).
Overall glycemia measured by CGM, decreased in the Bdiet by -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) in the 6Mdiet (p<0.05). Overall VAS100 hunger scores were reduced by -18 ± 3 in Bdiet, but increased by 2 ± 1.7 in 6Mdiet (p<0.05). Similarly, craving scores (especially for carbohydrates/starches) were augmented by 4 ± 5.1 with 6Mdiet, while in the Bdiet the craving scores were significantly reduced by -36 ± 7.7 (p<0.05).
At the end of the intervention, TDID increased by 2.2 units/day (from 67.8 ± 47.5 to 70.0 ± 51.1 units/day) in the 6Mdiet, whereas was significantly reduced by -20.5 ± 24.7 units/day (from 54.7 ± 26.8 to 34.8 ± 25.2 units/day) in the Bdiet (p<0.05).
Conclusions: In uncontrolled insulin treated T2D, the Bdiet was shown to be more effective than the traditional diet with six small meals evenly distributed along the day, for weight loss, overall glycemia, HbA1c, appetite and for the reduction of insulin requirements. Therefore the meal timing schedule, with high energy breakfast diet should be a strategy to improve diabetes control and outcome.

Daniela Jakubowicz, Oren Froy, Shani Tsameret, Julio Wainstein, Itamar Raz, Miriam Menaged, Yosefa Bar-Dayan, Naomi Mor, Tali Ganz, Zohar Landau

[link url=""]The Endocrine Society material[/link]
[link url="!/4482/presentation/6407"]ENDO 2018 abstract[/link]

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