Temporal distribution of carbohydrate and calorie intake is not associated with hemoglobin A1C in persons with type 2 diabetes mellitus

Abstract

The American Diabetes Association has no recommendation for distributing carbohydrate and calories throughout the day to optimize glycemic control in people with type 2 diabetes (T2DM). Past research suggests that timing of calorie and carbohydrate consumption may influence postprandial blood glucose and deserves attention. The aim of this study was to examine the temporal distribution of carbohydrate and calories over 24 hours in individuals with T2DM and determine association with hemoglobin A1C (A1C). Three or four 24-hour dietary recalls were collected from subjects with T2DM. Temporal macronutrient distribution was operationalized in this study by dividing each day into four 6-hour time periods: T1 (4:00 am to 9:59 am), T2 (10:00 am to 3:59 pm), T3 (4:00 pm to 9:59 pm) and T4 (10:00 pm to 3:59 am). Association between percent of calories and carbohydrate in each time period and A1C was determined using linear regression. Ninety-eight subjects (72% female) with median A1C of 6.9% (IQR 6.2, 7.8), and age 56 years old (IQR 48, 63) were included in analysis. Median percent of daily calories in T1, T2, T3, and T4 were 18.2%, 33.1%, 36.9%, and 0%, respectively. Median percent of daily carbohydrate in Ti, T2, T3, and T4 were 20.9%, 26.2%, 42.9%, and 0%, respectively. There was no significant association between any time periods and A1C, or between breakfast skipping and night eating and A1C. This suggests that for people with T2DM, distributing more daily calories or carbohydrates at certain time periods may not influence glycemic control.