Restricting carbohydrates at breakfast is sufficient to reduce 24-hour exposure to postprandial hyperglycemia and improve glycemic variability

Abstract

Background The breakfast meal often results in the largest postprandial hyperglycemic excursion in people with type 2 diabetes. Objective Our purpose was to investigate whether restricting carbohydrates at breakfast would be a simple and feasible strategy to reduce daily exposure to postprandial hyperglycemia. Design Adults with physician-diagnosed type 2 diabetes [n = 23; mean ± SD age: 59 ± 11 y; glycated hemoglobin: 6.7% ± 0.6%; body mass index (kg/m2): 31 ± 7] completed two 24-h isocaloric intervention periods in a random order. Participants consumed one of the following breakfasts: 1) a very-low-carbohydrate high-fat breakfast (LCBF; <10% of energy from carbohydrate, 85% of energy from fat, 15% of energy from protein) or 2) a breakfast with dietary guidelines–recommended nutrient profile (GLBF; 55% of energy from carbohydrate, 30% of energy from fat, 15% of energy from protein), with the same lunch and dinner provided. Continuous glucose monitoring was used to assess postprandial glucose responses over 24 h, and visual analog scales were used to assess ratings of hunger and fullness. Results The LCBF significantly reduced postprandial hyperglycemia after breakfast (P < 0.01) and did not adversely affect glycemia after lunch or dinner. As such, overall postprandial hyperglycemia (24-h incremental area under the glucose curve) and glycemic variability (mean amplitude of glycemic excursions) were reduced with the LCBF (24-h incremental area under the glucose curve: −173 ± 361 mmol/L; P = 0.03; mean amplitude of glycemic excursions: −0.4 ± 0.8 mmol/L · 24 h; P = 0.03) compared with the GLBF. Premeal hunger was lower before dinner with the LCBF than with the GLBF (P-interaction = 0.03). Conclusions A very-low-carbohydrate high-fat breakfast lowers postbreakfast glucose excursions. The effects of this simple strategy appear to be sufficient to lower overall exposure to postprandial hyperglycemia and improve glycemic variability. Longer-term interventions are warranted. This trial was registered at clinicaltrials.gov as NCT02982330.

Use of a diabetes-specific nutritional shake to replace a daily breakfast and afternoon snack improves glycemic responses assessed by continuous glucose monitoring in people with type 2 diabetes: a randomized clinical pilot study

“…Moreover, previous studies have shown that the type and amounts of foods consumed, including at breakfast, may have effects on glucose metabolism hours after consumption. 18 19 …”

“…As observed in our study, the morning glucose excursion also corresponds to the largest glycemic peak across the day. Controlled feeding studies 18–21 have reported that lowering postbreakfast glycemic responses improves glucose variability, suggesting that the early glucose peak is critical to the overall dysglycemia across the day. In free-living people with T2D, glycemic responses are superimposed on numerous internal (ie, chronobiological mechanisms) and external (eg, habitual diet quality, medications, physical activity, social, and emotional) factors which influence glucose levels and variability.…”

Glycemic Index (GI) or Glycemic Load (GL) and Dietary Interventions for Optimizing Postprandial Hyperglycemia in Patients with T2 Diabetes: A Review

“…Four studies included in the analysis compared reduced carbohydrate content with higher carbohydrate content meals and showed that reducing the amount of carbohydrates of a meal results in a lower GL of that meal, and therefore better glycemic control [ 24 , 25 , 26 , 27 ].…”

“…In a more recent randomized crossover trial, Chang et al [ 25 ] investigated the effect of altered nutrient breakfasts on postprandial glucose response, but instead of altering GI through replacement of high-GI foods with low-GI ones, they altered GL by reducing the total amount of carbohydrate, resulting in a low-carbohydrate breakfast (LCBF). In the LCBF, carbohydrates provided approximately 10% of energy.…”

“…In addition, breakfast composition seems to play a role in overall glycemic response because it is the meal that leads to the greatest postprandial hyperglycemic excursions [ 25 , 38 ]. Considering that postprandial glucose excursions are higher in the morning [ 8 ], it appears logical to focus on improving post-breakfast hyperglycemia, as it is a simple and practical strategy.…”