Glucagon, not a related hormone, is linked to higher blood sugar after lunch when skipping breakfast in Asian Indian patients with uncontrolled type 2 diabetes
Insulin resistance, measured by , was greater in breakfast skippers (3.05 ± 3.89 vs 2.03 ± 1.76, p = 0.007).
The incremental area under the curve for plasma glucose post-lunch was significantly higher in breakfast skippers (7623 ± 2947.9 mg/dl × min vs 1922.4 ± 1902.1 mg/dl × min, p < 0.001).
Glucagon levels also increased significantly in breakfast skippers compared to breakfast eaters (7272.7 ± 4077 pg/ml × min vs 4568.8 ± 2074.9 pg/ml × min, p = 0.044).
No significant differences were observed in GLP-1 levels or continuous glucose monitoring parameters such as average blood glucose and glycemic variability.
Simplified
INTRODUCTION: The effect and mechanism of skipping breakfast on glycemic control in type 2 diabetes mellitus (T2DM) in Asian-Indians is unknown.
METHODS: Cross-over, within-group study recruiting 5 habitual breakfast eaters (BE) and 5 habitual breakfast skippers (BS) with uncontrolled T2DM (HbA1c 7-9%). Patients underwent testing after three days of following their usual breakfast habits and after seven days of crossing over to the other arm. Fasting values and incremental area under the curve (iAUC) of post-lunch levels of glucose, insulin, C-peptide, glucagon-like peptide 1 (GLP-1), and glucagon were measured. Continuous glucose monitoring (CGM) parameters assessed were area under the curve (AUC) of post-meal glucose values, 24-hour average blood glucose (ABG), time in range (TIR), and glycemic variability. 0-180 0-180
RESULTS: BS led to significantly higher fasting (133.5 ± 34.5 mg/dl vs 110 ± 31.50 mg/dl,= 0.009) and peak post-lunch (214.6 ± 35.07 mg/dl vs 175.4 ± 39.26 mg/dl,< 0.001) plasma glucose, and (3.05 ± 3.89 vs 2.03 ± 1.76,= 0.007) as compared to BE. Post-lunch iAUCduring BS was significantly higher for plasma glucose (7623 ± 2947.9 mg/dl × min vs 1922.4 ± 1902.1 mg/dl × min,< 0.001), insulin (2460 ± 1597.50 mIU/ml × mins vs 865.71 ± 1735.73 mIU/ml × mins,= 0.028), C-peptide (418.4 ± 173.4 ng/ml × mins vs 127.8 ± 117.1 ng/ml × mins,< 0.001) and glucagon (7272.7 ± 4077 pg/ml × mins vs 4568.8 ± 2074.9 pg/ml × mins,= 0.044) as compared to BE, while GLP-1 (1812.7 ± 883 pmol/l × mins during BS vs 1643 ± 910 pmol/l × mins during BE,= 0.255) did not significantly differ between the two visits. CGM revealed a higher post-lunch AUCduring BS. There was no difference in post-dinner AUC, ABG, TIR, or glycemic variability. P P P P P P P P0-180 0-180 0-180
CONCLUSION: Skipping breakfast led to higher post-lunch glucose excursions, possibly due to higher glucagon excursion and increased insulin resistance.
Key numbers
214.6 ± 35.07 mg/dl
Increase in Peak Post-Lunch Plasma Glucose
Compared to 175.4 ± 39.26 mg/dl during breakfast eating.
7623 ± 2947.9 mg/dl × mins
Incremental Area Under the Curve for Plasma Glucose
Versus 1922.4 ± 1902.1 mg/dl × mins during breakfast eating.
3.05 ± 3.89
Increase
Compared to 2.03 ± 1.76 during breakfast eating.
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