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CHICAGO – A hearty breakfast, a medium lunch, and a light dinner might be the eating plan that can help diabetics reduce their dependence on insulin, researchers suggested here.

After 3 months on the big breakfast diet, patients who ate a high energy breakfast and had two smaller meals lost 11 pounds and used 20.5 fewer units of insulin a day from what they were using at the start of the trial, while patients who followed one of the traditional diabetes meals -- eating several meals across the day -- gained 3 pounds and used 2.2 more insulin units (P<0.05), reported Daniela Jakubowicz, MD, of the University of Tel Aviv in Israel.

"The hour of the day -- when you eat and how frequently you eat -- is more important that what you eat and how many calories you eat," said Jakubowicz at a press conference at ENDO, the annual meeting of The Endocrine Society. "The meal timing schedule, with a high energy breakfast diet, should be a strategy to improve diabetes control and outcome."

She said patients in the study, 11 women and 18 men, were divided into two groups. They were randomly assigned to eat diets of about 1,600 calories a day – but the big (high-energy) breakfast group had about 800 calories in the morning meal, and then about 550 calories at lunch and about 250 calories as the dinner meal, Jakubowicz told MedPage Today.

The other group consumed their food in diets that reflect usual eating patterns -- i.e., a light breakfast, a medium lunch, and a similar dinner, including three snacks during the day. The breakfast was supposed to be about 320 calories; lunch and dinner were 400 calories each, and the snacks were about 160 calories each.

Jakubowicz suggested that the latter diet plan among overweight, uncontrolled diabetes patients led to higher insulin use to contend with higher glucose readings, and the insulin use led to greater intake of foods and weight gain and worsening of diabetes control, and hence more insulin -- a vicious circle that resulted in less diabetes control and greater weight gain.

In addition to weight and reduced use of insulin, the main findings were as follows:

• Subjects in the study who were on the high-energy breakfast diet also recorded lower hunger scores on a visual analog scale; after 3 months, the average score for the group was reduced 18 points, compared with a two-point increase in the score of the patients on the comparator diet plan (P<0.05)
• Body mass index decreased by an average of 1.9 in the high-energy breakfast diet, but increased by 0.1 in those on the six-meal diet plan (P<0.05)
• HbA1c decreased by 1.2 from 8.2% to 7% in the high-energy breakfast group and decreased by 0.2% in those on the six-meal diet plan, from 7.9% to 7.7% (P<0.05)
• Overall glycemia measured by continuous glucose monitoring decreased in the high-energy breakfast diet by 38 mg/dl compared with a decrease of 17 mg/dl in the six-meal diet (P<0.05)

Participants in the study were about 69 years old, and body mass index was 32.2. Overall glycemia was assessed for 14 days at baseline and at the end of the intervention by continuous glucose monitoring, and the insulin dose was titrated biweekly.

Asked for her perspective, Anne Peters, MD, director of the Clinical Diabetes Programs at the Keck School of Medicine of the University of Southern California in Los Angeles, who was not involved with the study, told MedPage Today: "I think this diet idea has merit. I do this with some of my patients. I have always told my patients to eat dinner for breakfast and then don't eat after 7 pm. And eat a small dinner."

That said, Peters also suggested that doctors avoid "cookie cutter" diet plans for their patients: "No one diet plan fits everyone. We all have different metabolism rates."

She did note that the study had small numbers, so a larger study would be warranted to confirm the findings.

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