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Increased meal frequency ameliorates glucose metabolism, satiety in obese patients with IGT, T2DM

Stephen Padilla
18 Sep 2017

Increasing the frequency of meals (six-meal pattern), compared with a three-meal pattern, improves glucose metabolism and satiety in obese patients with impaired glucose tolerance (IGT) or type 2 diabetes mellitus (T2DM), according to a 24-week weight maintenance study presented at the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD 2017) in Lisbon, Portugal.

Researchers compared the effects of two isocaloric meal patterns (three vs six meals per day) on glycaemic control and satiety in patients (n=47) with: a) IGT (IGT-A; 2-hour plasma glucose: 140 to 199 mg/dl), b) in a group (IGT-B; 2-hour plasma glucose: 140 to 199 and/or ≥200 mg/dl at 30, 60 or 90 min) or c) T2DM.

A total of 15 individuals with IGT-A (aged 43.8±13.1 years; body mass index [BMI], 32.4±5.2 kg/m2; HbA1c, 5.6±0.1 percent), 20 individuals with IGT-B (aged 52.1±11.5 years; BMI, 32.5±5.0 kg/m2; HbA1c, 5.9±0.1 percent), and 12 newly diagnosed patients with T2DM not on diet or antidiabetic treatment (aged 51.7±11.7 years; BMI, 32.2±5.2 kg/m2; HbA1c, 6.6±0.1 percent) completed the study. None of the participants had any systemic disease.

Researchers recruited the participants from the outpatient unit of Attikon University Hospital in Athens, Greece, who followed a maintenance weight diet (%carbohydrates:protein:fat, 45:20:35) consumed either as a three- or six-meal pattern, with each intervention lasting 12 weeks.

The type and amount of any food and beverage consumed daily were recorded, and diaries of the participants were checked biweekly. Also, researchers assessed anthropometric measurements, diet compliance, subjective hunger, satiety and desire to eat (visual analogue scales [VAS], 1 to 10) biweekly.

To measure plasma glucose and plasma insulin, all participants underwent a 75-g oral glucose tolerance test (OGTT) at the beginning and end of each intervention. HbA1c and blood lipid were also measured at the beginning and end. Homeostatic model assessment-insulin resistance was calculated.

All participants had similar age and BMI at baseline. Individuals with T2DM had significantly higher fasting glucose and glycated haemoglobin (HbA1c) compared to both IGT-A and IGT-B; no significant differences were seen between the latter. [EASD 2017, abstract 840]

Overall, there was significant HbA1c, time and meal pattern interaction (p=0.02), as well as substantial main effect of group (by diagnosis; p<0.001) and of meal pattern (p=0.04) on HbA1c.

Hunger and desire to eat were lower among participants assigned to the six-meal pattern group compared with those in the three-meal pattern group (Hunger: VAS, 2.54 vs 3.30; p=0.01; Desire to eat: VAS, 3.50 vs 4.14; p=0.046).

A significant change was observed among T2DM patients assigned to the six- vs three-meal pattern group in HbA1c (‒0.36 vs ‒0.01 percent; p<0.001), 60’ post-OGTT glucose (‒17.93 vs 4.27 mg/dl; p=0.03) and 120’ post-OGTT glucose (‒42.65 vs 11.38 mg/dl; p=0.02). In addition, there was a significant change in peak glucose rise among IGT-B patients in the six- vs three-meal pattern group (‒11.77 vs ‒0.94 mg/dl; p=0.003).

There were no significant differences between intervention for incremental area under the curve (iAUC) of blood glucose, iAUC insulin, peak time for glucose/insulin, peak insulin rise and blood lipids.

“These results suggest that increased frequency of meals, consumed at regular times, may be a useful tool for clinicians treating patients with obesity and glucose abnormalities, especially those who are reluctant or unsuccessful dieters,” researchers said.

IGT is defined as time point between normal glucose tolerance and frank diabetes (asymptomatic, mild hyperglycaemia and postprandial hyperinsulinaemia), and T2DM refers to symptomatic patients with random plasma glucose ≥200 mg/dl, according to researchers.

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