Three or Six Meals a Day to Reduce Glycated Hemoglobin?

A study compared a three-meal diet (3Mdiet) with a carbohydrate-rich breakfast versus an isocaloric six-meal diet (6Mdiet) in patients with type 2 diabetes to determine which was more effective for weight loss and improved glycemic control. A total of 28 patients with diabetes (median body mass index, 32.4 kg/m2; median hemoglobin A1c [HbA1c], 8.1 [64.5 mmol/mol]) were randomized to either diet. Patients underwent evaluation at baseline, two weeks, and 12 weeks for body weight, glycemic control, continuous glucose monitoring (CGM), appetite, and clock gene expression. After 12 weeks, the 3Mdiet group had significant weight loss (–5.4 kg; P<0.01) and decreased HbA1c (–12 mmol/mol; 1.2%), while the 6Mdiet group did not. The 3Mdiet group also presented significantly lower fasting glucose and daily and nocturnal glucose levels. CGM revealed that the 3Mdiet group spent significantly less time in hyperglycemia. The 3Mdiet group reduced patients’ daily insulin dose by 26 units and resulted in significantly decreased hunger and cravings. In the 3Mdiet, compared with the 6Mdiet, clock genes demonstrated oscillation, increased expression, and higher amplitude.