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- Title
The Second Meal Effect in Type 2 Diabetes: A Physiologic Means of Limiting Postprandial Hyperglycemia.
- Authors
Jovanovic, Ana; Gerrard, Jean; Taylor, Roy
- Abstract
The rise in blood glucose after lunch has long been known to be less if breakfast has been taken. It has been assumed that this second meal effect is not present in type 2 diabetes. We studied 7 subjects with type 2 diabetes (diet ± metformin, duration 5.0 ± 0.6 years, 56.0 ± 2.8 years, 4M, 3F) to determine whether the same effect was present, and if so, to determine the underlying mechanism. The metabolic and hormonal changes after lunch were examined on Day A (breakfast taken); Day B (no breakfast); and Day C (no breakfast but with 30 grams of intravenous arginine pre-lunch). If breakfast was taken the rise in plasma glucose 2 hours after lunch was considerably less (Day A: 0.3 ± 05mmol/L; Day B: 4.4 ± 0.7mmol/L, p<0.008). The plasma insulin concentrations were similar (Day A: 88.0 ± 22.9 mU/L; Day B: 114.7 ± 36.7 mU/L). Pre-lunch plasma NEFA levels were suppressed when breakfast had been eaten (0.16 ± 0.02 vs. 0.65 ± 0.04 mmol/L). Arginine administration decreased the lunch rise in glucose (2.3 ± 0.4 vs. 4.4 ± 0.7mmol/L, p< 0.009) and this was associated with a suppression of pre-lunch NEFA (0.36 ± 0.05 vs. 0.65 ± 0.04 mmol/L). The extent of improvement in post-lunch plasma glucose was directly related to the degree of suppression of plasma NEFA, with a correlation between the pre-lunch arginine induced suppression of NEFA and the change in peak plasma glucose (r = 0.98). In conclusion, the second meal effect is present in subjects with type 2 diabetes. Mimicking the effect by pre- breakfast administration of a non-glucose insulin secretagogue has the potential to half the postprandial glucose rise and this could be of considerable benefit for overall glycemia control.
- Publication
Diabetes, 2007, Vol 56, pA407
- ISSN
0012-1797
- Publication type
Academic Journal