In type 2 diabetes, a low-carb breakfast reduces glucose increases.

According to a recent study published in The American Journal of Clinical Nutrition, a low-carbohydrate (LC) diet resulted in a 74% reduction in postprandial glucose and lower glycemic variability in type 2 diabetics when compared to those eating a typical low-fat breakfast.

Background
Glycemic variability and postprandial glucose rises are independent risk factors for heart disease and death in type 2 diabetes (T2D) patients. Similarly, everyday changes in blood glucose levels, such as hyper- and hypoglycemia, might raise the risk of diabetic complications.

Because heart disease is a major source of morbidity and death in T2D patients, measures to reduce postprandial glucose fluctuations and glycemic variability are critical. Although a low-carbohydrate diet is regarded as a powerful dietary approach for improved glucose management, poor dietary adherence can limit the advantages of this type of diet.

Carbohydrate ingestion produces a fast spike in blood glucose levels in those with T2D, especially in the morning. As a result, in persons with diabetes, one viable and simple option might be to lower the carbohydrate amount of only one meal per day, such as breakfast, without changing the macronutrient composition of other meals.

Concerning the research
During the coronavirus disease 2019 (COVID-19) pandemic, the researchers conducted a 12-week, two-site, parallel-arm randomized control experiment (RCT). The goal of this trial was to see if a low-carbohydrate meal might improve glucose management in people with T2D more than a low-fat breakfast.

T2D diagnosed by a physician, age between 20 and 79 years, current HbA1c of less than 69 mmol/L or 8.5%, blood pressure less than 160/99 mmHg, and a body mass index (BMI) larger than 25 kg/m2 were all required.

Smokers, people using exogenous insulin, people taking more than two glucose-lowering medications, people receiving treatment for autoimmune or inflammatory diseases, cancer, and liver or kidney disorders, people taking corticosteroids, hormone replacement therapy (HRT), or anti-inflammatory medications, people with allergies or some dietary restrictions, and people who were unable to follow the diet prescription were all excluded from the trial.

Due to pandemic constraints, study protocols were taught to participants, and digital permission was collected by research team members through video conference or telephone. The primary study endpoint was changed in HbA1c levels.

Participants self-reported anthropometrics, glucose monitoring, and food information were collected. To report physical activity, the subjects also completed the Godin Leisure-Time Exercise Questionnaire.

The study’s results
127 people with T2D met the inclusion criteria out of the 246 people who were pre-screened for the research. Following randomization, 60 people were allocated to the low-fat breakfast group and 61 to the LC breakfast group.

The individuals’ mean age was 64 years, their HbA1c was 7.0, and their BMI was 32.3 kg/m2, with 53% of them being women. While carbohydrate intake was much lower in the LC breakfast group, no significant variations in daily fat or protein intake were found.

HbA1c fell by roughly 0.3% after 12 weeks of having an LC breakfast; nevertheless, the between-group HbA1c difference was only marginally significant. There were no significant variations in BMI, weight, or waist circumference between the LC and low-fat groups. During the research period, no significant between-group variations in physical activity, hunger, or satiety were found.

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Total self-reported daily energy in the LC group was -242 kcal, and carbohydrate consumption was -73 g. Both values were lower than in the low-fat group, although their significance remained unclear. Glycemic variability, mean and maximum glucose, standard deviation, duration above range, and area under the curve were all considerably lower in the high-fat group.

Conclusions
There is a lot of evidence that carbohydrate restriction improves glycemic control in people with T2D. Although the primary result of the current study was not substantially different between the two groups, several other glucose monitoring indicators were better in the LC breakfast group over the monitoring periods than in the low-fat breakfast group. Longer and more controlled trials might lead to considerable HbA1c reductions in the LC group vs the low-fat group.

Despite being a remote trial with limited monitoring, the current study found that breakfast treatments were well-accepted. High feasibility of the LC breakfast was also found across the 12-week trial period, demonstrating that moderate carbohydrate limitations are simpler for individuals to adhere to than severe carbohydrate restrictions.

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Overall, the study findings show that eating a low-carbohydrate breakfast may be a simpler and more successful dietary strategy for lowering overall carbohydrate and energy consumption and improving numerous glucose monitoring factors in people with T2D than eating a low-fat meal.

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