Low-carb breakfast could help patients with type 2 diabetes manage glucose

Key takeaways:

• A low-carbohydrate breakfast was associated with improvements in continuous glucose monitoring variables.
• After a 12-week intervention, HbA1c was reduced in the low-carb breakfast group by 0.3%.

Having a low-carbohydrate breakfast may be a simple method to reduce HbA1c for those with type 2 diabetes, according to the results of a randomized trial published in the American Journal of Clinical Nutrition.

Jonathan P. Little, PhD, MSc, a professor at the University of British Columbia, and colleagues wrote that for people with type 2 diabetes, consuming carbohydrates results in a large, rapid increase in blood glucose, especially in the morning.

“Individuals with type 2 diabetes tend to have the largest glucose spike in the morning after the breakfast meal; the simple switch to a low-carbohydrate breakfast might be an easy way for people living with type 2 diabetes to improve glucose control,” Little told Healio. “We know that post-meal blood glucose spikes are linked to diabetes complications, particularly damage to blood vessels.”

Little and colleagues conducted a randomized trial to investigate whether a low-carbohydrate (LC) breakfast, which they defined as roughly 465 kcal composed of 25 g of protein, 8 g of carbohydrates and 37 g fat, could improve glucose control among those with type 2 diabetes compared with a low-fat control diet — 450 kcal composed of 20 g protein, 56 g carbohydrates and 15 g fat.

The 3-month, remote, parallel-group trial included 121 participants with type 2 diabetes, 53% of whom were women, with a mean age of 64 years.

“The study was conducted completely remotely during the COVID pandemic, with participants meeting once at the start of the study with a study dietitian and then all materials mailed to them,” Little said. “Participants in the study were provided with a menu book with eight to 10 low-carbohydrate or low-fat breakfast options that they would prepare at home based on their group assignment.”

Little and colleagues reported that consuming a LC breakfast improved several continuous glucose monitoring variables and reduced carbohydrate intake compared with the control breakfast.

“We found that when individuals with type 2 diabetes were provided advice and guidance to consume a low-carbohydrate breakfast (eg, eggs) compared to a low-fast breakfast (eg, oatmeal) that glucose control measured by continuous glucose monitoring was better after breakfast and throughout the day,” Little said.

After 12 weeks of a LC breakfast, HbA1c was reduced in the low-carbohydrate breakfast group (–0.3%; 95% CI, –0.4 to –0.1), but the difference was of “borderline statistical significance” (–0.2; 95% CI, 0.4-0), favoring the low-carbohydrate group,” the researchers wrote.

Additionally, self-reported carbohydrate intake (–73 g; 95% CI, –101 to –44) and total daily energy (–242 kcal; 95% CI, –460, –24 kcal) were lower in the LC group. The significance of this difference, they wrote, is unclear.

“Consuming a low-carbohydrate breakfast reduces or eliminates the largest glucose spike of the day and lowers overall glycemic variability,” Little said. “Our results are promising, but future studies will need to confirm if this simple meal switch can lower long-term complications.”

He added that physicians should “consider recommending a low-carbohydrate breakfast to patients instead of standard low-fat guidelines.”

“Scrambled eggs, fried eggs, an egg omelet or nonsweetened Greek yogurt are all great options,” he said.