Those in the three-meal (3m) group took 50% of their calories at breakfast, mostly from carbohydrates and protein, and consumed by 9:30 a.m. One-third of their calories were consumed at lunch, and the final 17% at dinner, where carbohydrates were not allowed. Between-meal snacking on vegetables was allowed. The six-meal (6m) group took 20%, 25%, and 25% of their calories at breakfast, lunch, and dinner, plus three snacks each consisting of 10% of their daily caloric intake. The study included a few more men than women, and insulin was titrated biweekly in the two groups as needed.
The groups were statistically identical at baseline, with a mean age of about 70 years, a 20-year or so history of type 2 diabetes, and a mean body mass index (BMI) of just under 33 kg/m2. However, at the end of 3 months, the 3m group was doing much better.They had lost a mean of 5.4 kg at that point and reduced their BMI by a mean of 1.9 kg/m2 and their HbA1c 1.2%. The 6m group, meanwhile, gained a mean of 0.26 kg, increased their BMI 0.1 kg/m2, and dropped their HbA1c only 0.2%. Both groups started with a mean HbA1c of around 8%.
Hunger and craving scores improved in the 3m group, as well, and their total daily insulin dose dropped 27 units from a baseline of 74 units; 6m subjects went up 5 units/day, from a baseline of 71 units. The findings were all statistically significant.
In short, the 3m is “more effective than the traditional diet with six small meals evenly distributed along the day, for weight loss, overall glycemia, HbA1c, appetite, and for the reduction of insulin requirements. Therefore, the three-meal schedule with a high-energy breakfast “should be a strategy to improve diabetes control and outcome,” Dr. Jakubowicz said at the annual meeting of the Endocrine Society.