The second meal phenomenon in type 2 diabetes

Abstract

Objective - In health, the rise in glucose after lunch is less if breakfast has been taken. We evaluated the second-meal effect in Type 2 diabetes.

Research Design and Methods - Metabolic changes after lunch in 8 obese Type 2 diabetic subjects were compared on 3 days: breakfast taken; no breakfast; no breakfast but intravenous arginine 1 hour pre-lunch).

Results - Despite comparable insulin levels, the rise in plasma glucose after lunch was considerably less if breakfast had been taken (0.68±1.49 vs. 12.32±1.73 vs. 7.88±1.03 mmol.h/l; p<0.0001). Arginine administration almost halved the lunch rise in plasma glucose (12.32±1.73 vs. 7.88±1.03 mmol.h/l). The plasma FFA concentration at lunch time directly related to plasma glucose rise after lunch (r=0.67, p=0.0005).

Conclusions - The second-meal effect is preserved in Type 2 diabetes. Pre-meal administration of a non-glucose insulin secretagogue results in halving the postprandial glucose rise and has therapeutic potential.