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A breakfast-centered meal plan for people with diabetes: A modest cohort study under free-living conditions

Elsamma Chacko*, Phyllis Awruch & Elina Schwartz

Aim: To test the efficacy of a new breakfast centered meal plan in improving weight, waist circumference, HbA1c and in preventing hypoglycaemia in people with diabetes and pre-diabetes under free-living conditions.

Methods: Twenty-three adults with type 2 diabetes or pre-diabetes received half-day training in a personalized, low-carb meal plan which typically included one big breakfast and 4-5 small meals/snacks. Carb intake was individualized using ADA and AACE

guidelines: ppg of <180 mg/dL (10.0 mmol/L) for the big meal (preferably breakfast) and <140 mg/dL (7.8 mmol/L) for the small meals. The subjects were also instructed not to eat during the three hours prior to bedtime. Reminders were through monthly meetings, and by phone or e-mail.

Results: Of the 23 people trained, 11 (48%) adhered to the meal plan for 3 months. The subjects included 1 man and 10 women, age 47-69, BMI 27-39 Kg/m². Four had pre-diabetes and 7 had type 2 diabetes. Four took no diabetes medications, one type 2 patient was on insulin and the rest took oral agents for diabetes. Average weight reduction was 6 lbs (range +2 to -22). HbA1c came down by 0.5% (+0.2 to -1.66). Fasting glucose decreased by 44 mg/dL (+12 to -151). Waist circumference decreased by 0.47 inches, (+2” to -3.5”) but was not a statistically significant. Glucose variability has been minimum for this meal plan by design. No hypoglycaemia or other adverse events intervened. All 11 subjects noted that eating close to bedtime raised fasting glucose. The consensus was that they were eating healthier than before and no instances of excessive hunger or hypoglycaemia occurred.

Conclusion: A breakfast-centered (big breakfast and 5 small meals) offered improved satiety, weight, fasting glucose, glycemic variability and HbA1c under free-living conditions for people with diabetes and pre-diabetes – without precipitating hypoglycaemia.