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Skipped meals complicate management of insulin-treated diabetic patients. A new study suggests that skipping breakfast might affect glycemic control even in patients who are not taking insulin.
Researchers enrolled 22 patients (mean age, 57; mean glycosylated hemoglobin level, 7.7%) whose type 2 diabetes was controlled by diet or metformin only. All patients were studied on one day when they ate three meals and again on one day when they skipped breakfast and ate only two meals. Meals were standardized (prepared by the researchers), so the only difference between the two study days was the presence or absence of breakfast.
On no-breakfast days, mean peak glucose excursions after lunch and after dinner were significantly higher (by 40% and 25%, respectively) — and post-lunch and post-dinner insulin levels were lower — than on breakfast days. Other observations on no-breakfast days were higher levels of free fatty acids (FFAs) and lower levels of glucagon-like peptide-1 (GLP-1); both higher FFA and lower GLP-1 levels have downstream metabolic effects that potentially raise plasma glucose levels.
Jakubowicz D et al. 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. Diabetes Care 2015 Oct; 38:1820. (http://dx.doi.org/10.2337/dc15-0761)
Comment
Skipping breakfast appears to affect glucose homeostasis adversely later in the day in patients with diet-controlled or metformin-treated type 2 diabetes. One explanation discussed by the authors is a “second-meal phenomenon,” in which the first meal (breakfast) induces enhanced β cell responsiveness later in the day. Whether this phenomenon has important long-term clinical implications is unknown.