The Second-Meal Phenomenon in Type 2 Diabetes

OBJECTIVE — In health, the rise in glucose after lunch is less if breakfast is eaten. We evaluated the second-meal effect in type 2 diabetes. RESEARCHDESIGNANDMETHODS — Metabolic changes after lunch in eight obese type 2 diabetic subjects were compared on 3 days: breakfast eaten, no breakfast, and no breakfast but intravenous arginine 1 h before lunch. RESULTS — Despite comparable insulin levels, the rise in plasma glucose after lunch was considerably less if breakfast had been eaten (0.68 1.49 vs. 12.32 1.73 vs. 7.88 1.03 mmol h1 l1; P 0.0001). Arginine administration almost halved the lunch rise in plasma glucose (12.32 1.73 vs. 7.88 1.03 mmol h1 l1). The plasma free fatty acid concentra-tion at lunchtime directly related to plasma glucose rise after lunch (r 0.67, P 0.0005). CONCLUSIONS — The second-meal effect is preserved in type 2 diabetes. Premeal admin-istration of a nonglucose insulin secretagogue results in halving the postprandial glucose rise and has therapeutic potential. Diabetes Care 32:1199–1201, 2009 The effect of a prior meal in decreas-ing the rise in blood glucose after asubsequent meal was first recog-nized almost a century ago (1). It has re-peatedly been confirmed in healthy subjects, but tests with intravenous or oral glucose suggested that the second-meal effect does not occur in type 2 dia-betes (2 – 4). We observed incidentally that a second meal in subjects with type 2 diabetes brought about a 70 % lesser rise in blood glucose (5). This study was designed to determine whether the second-meal phenomenon is present in type 2 diabetes and, if so, whether this can artificially be induced as a possible therapeutic approach