Reduction in Glycated Hemoglobin and Daily Insulin Dose Alongside Circadian Clock Upregulation in Patients With Type 2 Diabetes Consuming a Three-Meal Diet: A Randomized Clinical Trial
Open Access
- 23 September 2019
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 42 (12), 2171-2180
- https://doi.org/10.2337/dc19-1142
Abstract
In type 2 diabetes, insulin resistance and progressive β-cell failure require treatment with high insulin doses, leading to weight gain. Our aim was to study whether a three-meal diet (3Mdiet) with a carbohydrate-rich breakfast may upregulate clock gene expression and, as a result, allow dose reduction of insulin, leading to weight loss and better glycemic control compared with an isocaloric six-meal diet (6Mdiet). Twenty-eight volunteers with diabetes (BMI 32.4 ± 5.2 kg/m2 and HbA1c 8.1 ± 1.1% [64.5 ± 11.9 mmol/mol]) were randomly assigned to 3Mdiet or 6Mdiet. Body weight, glycemic control, continuous glucose monitoring (CGM), appetite, and clock gene expression were assessed at baseline, after 2 weeks, and after 12 weeks. 3Mdiet, but not 6Mdiet, led to a significant weight loss (−5.4 ± 0.9 kg) (P < 0.01) and decreased HbA1c (−12 mmol/mol [−1.2%]) (P < 0.0001) after 12 weeks. Fasting glucose and daily and nocturnal glucose levels were significantly lower on the 3Mdiet. CGM showed a significant decrease in the time spent in hyperglycemia only on the 3Mdiet. Total daily insulin dose was significantly reduced by 26 ± 7 units only on the 3Mdiet. There was a significant decrease in the hunger and cravings only in the 3Mdiet group. Clock genes exhibited oscillation, increased expression, and higher amplitude on the 3Mdiet compared with the 6Mdiet. A 3Mdiet, in contrast to an isocaloric 6Mdiet, leads to weight loss and significant reduction in HbA1c, appetite, and overall glycemia, with a decrease in daily insulin. Upregulation of clock genes seen in this diet intervention could contribute to the improved glucose metabolism.Keywords
Funding Information
- Israeli Ministry of Health (3-00000-12856)
This publication has 49 references indexed in Scilit:
- Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus ReportDiabetes Care, 2019
- Insulin Therapy Increases Cardiovascular Risk in Type 2 DiabetesProgress in Cardiovascular Diseases, 2017
- Metabolic impacts of altering meal frequency and timing – Does when we eat matter?Biochimie, 2016
- Omitting Late-Night Eating May Cause Hypoglycemia in “Well Controlled” Basal Insulin-Treated Type 2 DiabetesEndocrine Practice, 2015
- Factors Associated With Weight Gain in People With Type 2 Diabetes Starting on InsulinDiabetes Care, 2014
- Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snackingThe American Journal of Clinical Nutrition, 2012
- Use of Twice-Daily Exenatide in Basal Insulin–Treated Patients With Type 2 DiabetesAnnals of Internal Medicine, 2011
- Position of the American Dietetic Association: Weight ManagementJournal of the American Dietetic Association, 2009
- The Treat-to-Target TrialDiabetes Care, 2003
- Metabolic Effects of Alterations in Meal Frequency in Type 2 DiabetesDiabetes Care, 1997