Diabetes Self-Management Blog

As the saying goes, breakfast is the most important meal of the day, and according to new research presented at the annual meeting of the European Association for the Study of Diabetes (EASD), this may indeed be the case — at least as far as people with Type 2 diabetes are concerned.

In past research, eating breakfast has been associated with lower body-mass index (a measurement of weight relative to height) and fasting blood fats and improved insulin sensitivity. To determine the effect of the size and nutrient composition of breakfast on blood glucose control, researchers in Israel recruited 59 adults with Type 2 diabetes to eat either a big breakfast or a small breakfast.

The 29 participants assigned to the big-breakfast group consumed 33% of their daily calories in their morning meal, which was composed of up to 30% protein and up to 37% fat, with the remainder of calories coming from carbohydrate. The 30 participants assigned to the small-breakfast group ate 12.5% of their daily calories at breakfast, with up to 70% of the meal coming from carbohydrate.

At the end of the three-month study period, 23 people in each group had completed the program. The researchers found that those in the big-breakfast group experienced an average A1C reduction of 0.460% and an average fasting blood glucose decrease of 14.51 mg/dl, compared to reductions of 0.146% and 4.91 mg/dl, respectively, in the small-breakfast group.

Additionally, those in the big-breakfast group had lost an average of 2.43 kg (approximately 5.35 pounds) and seen a reduction in systolic blood pressure (the top number) of 9.58 mmHg, compared to reductions of 1.86 kg (roughly 4.10 pounds) and 2.43 mmHg in the small-breakfast group. Members of the big breakfast group also reported that they were less hungry later in the day — likely the result of reduced levels of the hunger hormone ghrelin — while those in the small breakfast group experienced increased feelings of hunger.

Moreover, about one-third of the big-breakfast eaters were able to reduce the amount of diabetes medicine they took daily, while roughly 17% of the small-breakfast eaters had to increase their use of diabetes medicines.

“In this study the Type 2 diabetics on the big breakfast had low carbohydrates and high fat and high protein, and they appeared to have better glycemic control,” noted presentation moderator Andreas Pfeiffer, MD. “There are a number of studies which are going in the same direction and which appear to reinforce and support that view, so having a good breakfast in the morning and then a second meal in the afternoon and a little [meal] in the evening appears to be a good scheme.”

He added, however, that for people with diabetes and kidney problems, the diet may not be ideal due to its high protein content.

Because the study has not yet been published in a peer-reviewed journal, the findings should be considered preliminary. Limitations of the trial include its small size and short duration.

For more information, read the article “Hearty Breakfast Good in Type 2 Diabetes” or review the presentation abstract on the Web site of the EASD. And to learn more about managing your blood glucose levels, click here.

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Comments
  1. It’s nice to see that my instincts are right on, in this case: “I am doing something right!” Even when planning out my (then imaginary) meals during a recent diabetes education class, I immediately went from 3 even carb choices per day, to more in the morning.

    Posted by Nicola |
  2. The only addition I would make to this advice is to be sure to have a hi-protein snack before bedtime.

    Posted by carol a. preece |
  3. So exactly what is considered a large breakfast? What do you eat?

    Posted by Laverne |
  4. Regarding article by Diane Fennell “Big breakfast for Diabetic control”… what are some examples of these breakfasts?

    Posted by Georgia Caldwell |
  5. Many years ago when I heard the saying, “Breakfast like a queen, lunch like a princess, and dine like a pauper”, I followed it to plan my meals. (Well, I feminized it.) I’m glad it took a study to prove an old adage correct.

    Posted by Dawn |
  6. What’s wrong with this study to me is the fact that the group with the better results consumed 33% of the meal as carbs, while the other group consumed 70% of the meal as carbs! Duh! I used to eat a bigger breakfast with 1/3 of it from carbs. My post-breakfast blood sugars were way too high. Now, I eat a small breakfast of greek yogurt, 1/2 cup fruit, & chopped almonds. My post-breakfast blood sugars are way down and so is my weight. I have cut my carbs at lunch also and eat a normal amount at dinner with no low or high BS problems. This is what is working for me. Also, my A1c is below 6 now.

    Posted by Pam |
  7. Hi Laverne and Georgia,

    Thanks for your questions. I have not been able to find any information indicating exactly what those in the big breakfast group ate for their first meal of the day, so I have contacted one of the study’s authors for further information. I’ll let you know as soon as I’ve heard back from her.

    Thank you for your interest in DiabetesSelfManagement.com!

    Best,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  8. Hello,

    I’ve just heard back from Dr. Daniela Jakubowicz, MD, one of the study’s authors. According to her, those in the big breakfast group ate foods such as eggs, 5% cheeses (for example, white cheese and cottage cheese), tuna fish, yogurt, bread, salad, and olives.

    For women on a 1200-calorie-a-day diet, the big breakfast was a total of 400 calories and was composed of the following foods:

    -1–2 slices of bread
    -150 grams of 5% cottage cheese
    -egg
    -salad
    -3% yogurt

    Thank you to Dr. Jakubowicz for the information!

    Best,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  9. Thank you at least now we have someidea of what they meant by a large breakfast.

    Posted by Laverne |
  10. In America, 400 calories is not considered a “big breakfast.”

    One of the pitfalls of making conclusions from research done overseas is the terminology and cultural norms are quite different. If one only read the headline (and lots of people do just that) many folks in the US would assume it suggests a dibetic should start their day with a Denny’s Lumberjack Grand Slam (about 1,200 calories).

    Posted by Joe |
  11. Yeah, Joe you hit it right on the head with the “big breakfast.” And as far as the choices offered by Dr. Jabubowicz, it will be a cold day in July and me starving before I can even consider eating a salad, olives or tuna fish (really?)for breakfast. I really like my yogurt, cereal, fruit or egg,1 slice bread, 1 slice bacon breakfast. So far these are working for me as my “big breakfast.”

    Posted by Linda Martin |
  12. That’s funny. This goes against evolutionary theory scientist like to brag about.

    If evolutionary theory is true breakfast would be the smallest of the meals in the morning as the caveman would not have time to hunt.

    That means the largest meal would be in the afternoon or evening. It would take time to prepare if he was lucky.

    I myself don’t eat in the morning as generally I am not hungry. Lunch is when I get hungry and my biggest meals are usually dinner.

    That said I am the skinniest of all my family who are all overweight. I do not believe when they say you should have the biggest meal at breakfast.

    When I do that I get lazy afterwards. Plus you cannot make a good meal at breakfast unless you like to start at 3AM for stews, soups, roast chicken, etc., or you’ll forever be eating only breakfast food.

    Posted by Beano |
  13. So exactly what is considered a large breakfast? What do you eat
    I agree ,, Please don’t tell us to eat a big breakfast, then not give us an idea of what exactly you expect us to eat, what might be a big breakfast to you and what it means to us is probably completely different.
    Please follow up on this ,, thanks ruth

    Posted by ruth |
  14. Hi Ruth,

    Thanks for your question. Please see my comment above (posted Oct 02, 2013 at 2:47 pm) for more information on what was considered a “big breakfast” in this study.

    Best,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  15. How long after I get up do I need to eat for it to be considered breakfast? I usually eat around 10:30 after I get to work, whether I get up at 6am, 7am, 8 am…am I outside the boundaries of breakfast by waiting? I don’t have time before that.

    Posted by Marta S |
  16. As a retired science teacher, I am always skeptical of studies with such a small sample size. Oh, that someone in the US might do a larger study and see if the results persist. Then we can change our lives to occasionally enjoy this larger breakfast, without the salad!!

    Posted by CathyB. |
  17. Beano: Your hypothesis assumes that ancient people would have only hunted in the day and didn’t eat vegetation or store food.

    Posted by Joe |

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