Background: For people with type 2 diabetes mellitus (T2DM), the frequency and/or composition of the morning meal may be especially important as the disease associated hormonal and metabolic perturbations contribute significantly to poor glucose control and weight gain. Few well-controlled studies have evaluated the effects of skipping breakfast and nutrient composition on metabolic outcomes in T2DM. This study evaluated the impact of consuming one of two convenient and healthful breakfast options versus skipping breakfast on postprandial blood glucose, insulin, glucagon-like peptide-1 (GLP-1), total energy intake and appetite.
Materials and methods: This was a randomized, controlled, non-blinded, three- treatment, crossover study conducted at two sites. All subjects (n=32) had T2DM. On study day mornings, fasted subjects consumed each test meal in random order: the two nutritional interventions administered were (1) a typical whole food breakfast meal consisting of oatmeal (OAT; 200 kcals, 8g protein, 36g carbohydrate (CHO), 6g fiber, 4g fat) and (2) a calorically-matched glycemia-targeted specialized-nutrition (GTSN; 216 kcals, 10g protein, 29g CHO, 2g fiber and 8g fat) compared to (3) skipping breakfast (SBF). Blood samples for measurement of plasma glucose, insulin and GLP-1 and appetitive responses were collected at baseline (pre-meal) and after consumption of the test meal over 180 minutes.
Results: Postprandial plasma glucose positive area under the curve (pAUC) mean was significantly reduced by 38% (based on individual percent changes) after GTSN compared to OAT. The SBF had the smallest glucose pAUC mean of all interventions. GLP-1 postprandial pAUC median of individual percent changes was significantly elevated after the consumption of GTSN by 280% compared to OAT and 995% compared to SBF. Subjective hunger pAUC mean was significantly elevated and fullness significantly lower after SBF compared to both the OAT and GTSN. No differences in hunger or fullness were observed between the GTSN and OAT interventions.
Conclusion: This study demonstrated that utilization of GTSN improved glycemic control and elevated GLP-1 levels compared to a healthful breakfast food and breakfast skipping without negatively impacting appetitive response or energy intake. These results suggest that GTSN containing slowly digesting carbohydrates and monounsaturated fatty acids (MUFA) may provide additional metabolic benefits when used as a meal replacement compared to oatmeal and breakfast skipping for people with T2DM.
Keywords: Type-2 diabetes, diabetes specific formula, glucose control, GLP-1, breakfast