Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial

Daniela Jakubowicz; Julio Wainstein; Bo Ahren; Zohar Landau; Yosefa Bar-Dayan; Oren Froy

doi:10.2337/dc15-0761

Clinical Care/Education/Nutrition/Psychosocial Research

Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial

Daniela Jakubowicz¹,² ⇑,
Julio Wainstein¹,
Bo Ahren³,
Zohar Landau¹,
Yosefa Bar-Dayan¹ and
Oren Froy⁴ ⇑

¹Diabetes Unit, Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
²Diabetes Unit, Department of Internal Medicine, Hospital de Clinicas Caracas, Central University of Venezuela, Caracas, Venezuela
³Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
⁴Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel

Corresponding authors: Daniela Jakubowicz, daniela.jak{at}gmail.com, and Oren Froy, oren.froy{at}mail.huji.ac.il.

Diabetes Care 2015 Oct; 38(10): 1820-1826. https://doi.org/10.2337/dc15-0761

Abstract

OBJECTIVE Skipping breakfast has been consistently associated with high HbA_1c and postprandial hyperglycemia (PPHG) in patients with type 2 diabetes. Our aim was to explore the effect of skipping breakfast on glycemia after a subsequent isocaloric (700 kcal) lunch and dinner.

RESEARCH DESIGN AND METHODS In a crossover design, 22 patients with diabetes with a mean diabetes duration of 8.4 ± 0.7 years, age 56.9 ± 1.0 years, BMI 28.2 ± 0.6 kg/m², and HbA_1c 7.7 ± 0.1% (61 ± 0.8 mmol/mol) were randomly assigned to two test days: one day with breakfast, lunch, and dinner (YesB) and another with lunch and dinner but no breakfast (NoB). Postprandial plasma glucose, insulin, C-peptide, free fatty acids (FFA), glucagon, and intact glucagon-like peptide-1 (iGLP-1) were assessed.

RESULTS Compared with YesB, lunch area under the curves for 0–180 min (AUC_0–180) for plasma glucose, FFA, and glucagon were 36.8, 41.1, and 14.8% higher, respectively, whereas the AUC_0-180 for insulin and iGLP-1 were 17% and 19% lower, respectively, on the NoB day (P < 0.0001). Similarly, dinner AUC_0-180 for glucose, FFA, and glucagon were 26.6, 29.6, and 11.5% higher, respectively, and AUC_0-180 for insulin and iGLP-1 were 7.9% and 16.5% lower on the NoB day compared with the YesB day (P < 0.0001). Furthermore, insulin peak was delayed 30 min after lunch and dinner on the NoB day compared with the YesB day.

CONCLUSIONS Skipping breakfast increases PPHG after lunch and dinner in association with lower iGLP-1 and impaired insulin response. This study shows a long-term influence of breakfast on glucose regulation that persists throughout the day. Breakfast consumption could be a successful strategy for reduction of PPHG in type 2 diabetes.

Footnotes

Clinical trial reg. no. NCT01571310, clinicaltrials.gov.
A slide set summarizing this article is available online.

Received April 12, 2015.
Accepted June 17, 2015.

© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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