To the Editor: In their recent article in Diabetologia [1], Jakubowicz and colleagues compared two meal plans: a high-energy breakfast and small supper vs a small breakfast and high-energy supper in type 2 diabetic patients. The results indicated reduced postprandial hyperglycaemia throughout the day with the meal plan featuring the high-energy breakfast. Kahleova and colleagues also reported that eating two meals a day, breakfast and lunch, is a better plan than eating six meals a day [2]. This is consistent with the finding that missing breakfast is associated with an increased risk of type 2 diabetes and worsening metabolic measures [3]. (The omission of breakfast means prolonging counter-regulation, and eating breakfast means switching to insulin action.) Taken together, these results can be seen as indicating that early switching of the hormone system from counter-regulation to insulin action and decreasing NEFA (and the resulting second-meal phenomenon) are important for diabetic patients [1]. A sensible meal plan for diabetic patients could involve distributing the total daily energy content among a big balanced breakfast, moderate lunch and a small supper. Such a meal plan offers favourable hormone levels, improved glucose profile and minimal hypoglycaemia risk [1, 2].
This moderate glucose profile can be further improved by timely post-meal exercise after the major meal—breakfast in this case. It has been known for more than three decades that a bout of light to moderate aerobic activity for up to 60 min, starting 30 min after the first bite of a meal, can blunt the post-meal glucose peak [4, 5]. This is because the bulk of the meal-derived glucose is used up by the activity when glucose and insulin levels are high and counter-regulation is suppressed. Exercise before breakfast is known to increase glucose levels via endogenous glucose production [6]. There is also evidence that adding a short bout of resistance exercise before the aerobic activity, two or three times a week, improves physical fitness, body composition and HbA1c [7].
A balanced breakfast followed by timely post-meal exercise could be a wise way to start the day for type 2 diabetic patients. Indications are that type 1 patients also could benefit from timely post-meal exercise after the main meal of the day [4]. Co-ordinating meals and exercise as described here would not violate current diabetes guidelines [8]. Long-term studies of the effect of such a lifestyle on HbA1c and lipids would be useful.
References
Jakubowicz D, Wainstein J, Ahrēn B et al (2015) High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial. Diabetologia. doi:10.1007/s00125-015-3524-9
Kahleova H, Belinova L, Malinska H et al (2014) Eating two larger meals a day (breakfast and lunch) is more effective than six smaller meals in a reduced-energy regimen for patients with type 2 diabetes: a randomised crossover study. Diabetologia 57:1552–1560
Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB (2012) Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr 95:1182–1189
Nelson JD, Poussier P, Marliss EB, Albisser AM, Zinman B (1982) Metabolic response of normal man and insulin-infused diabetics to postprandial exercise. Am J Physiol 242:E309–E316
Colberg SR, Zarrabi L, Bennington L et al (2009) Post-prandial walking is better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals. J Am Med Dir Assoc 10:394–397
Kjaer M, Hollenbeck CB, Frey-Hewitt B et al (1990) Glucoregulation and hormonal responses to maximal exercise in non-insulin-dependent diabetes. J Appl Physiol 68:2067–2074
Snowling NJ, Hopkins WJ (2006) Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients. Diabetes Care 11:2518–2527
American Diabetes Association (2015) Standards of medical care in diabetes—2015: summary of revisions. Diabetes Care 38(Suppl 1):S4
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Chacko, E. Co-ordinating meals and exercise for diabetes management. Diabetologia 58, 1372–1373 (2015). https://doi.org/10.1007/s00125-015-3576-x
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DOI: https://doi.org/10.1007/s00125-015-3576-x