Protein at Breakfast Improved Glycemic Control in Obese Adults With Type 2 Diabetes

Honey Waffle

High protein, egg-based breakfast affected insulin and incretin responses at a subsequent meal, suggesting breakfast meal composition may be important for those with type 2 diabetes.

With high rates of type 2 diabetes in the U.S. and on the rise globally, there is a need to better understand the impact of macronutrient composition on glucose and insulin homeostasis in this population.

Dr. Jill Kanaley and colleagues recently evaluated the effects of two different 500 kcal breakfast meals in a crossover study design in 12 obese adults with type 2 diabetes. The breakfast meal was followed 4 hours later by a standard high-carbohydrate lunch. Concentrations of glucose, insulin, and the incretins, GLP-1 and GIP, were measured throughout the day.

Breakfast meals were waffles and syrup formulated to be high in protein (35% energy protein and 45% energy carbohydrate) or normal protein (15% energy protein and 65% energy carbohydrate). The high-protein waffles contained a greater proportion of whole eggs. Both breakfasts were matched for simple sugars (15.3 grams), fiber (9.3 grams) and fat content (11.0 grams).

Subjects continued on medications, when needed; most were taking metformin. Other diabetes medications were excluded from the study (i.e., insulin, GLP-1 agonists).

Research showed:

“overall 8-hour glucose AUCs [area under the curves] on the protein day were lower than on the carbohydrate day as expected (-10%, P<0.05).”

“This difference was mostly driven by the attenuated post breakfast AUC on the protein day compared with the carbohydrate day (-16%, P<0.05).”

A greater GLP-1 response during the 8-hours after the high-protein breakfast in this study may be an underlying mechanism for lower blood glucose.

In addition to studying the effects of breakfast throughout the morning (i.e., main meal effect), the research team also looked at the “second meal” effect, hypothesizing there may be residual or compensatory changes after the standard high-carbohydrate lunch meal. Results showed that there were no differences between breakfast types with respect to post-lunch meal effects on glycemic response, however the insulin and GIP responses were greater on the high-protein breakfast day compared to the normal-protein breakfast.

The authors concluded:

“This first meal appears critical in maintaining glycemic control at the subsequent meal by priming the beta cells to increase insulin concentrations and the gut to release GIP, resulting in a second-meal phenomenon.”

Reference Citation

Park, YM, TD Heden, Y Liu, LM Nyhoff, JP Thyfault, HJ Leidy, and JA Kanaley. “A high-protein breakfast induces greater insulin and glucose-dependent insulin tropic peptide responses to a subsequent lunch meal in individuals with type 2 diabetes.” J Nutr 2015;145:452-458. This study was supported in part by the Egg Nutrition Center.

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