Breakfast change could help young people with Type 1 Diabetes

A simple change to breakfast food could help children and young people with Type 1 Diabetes better manage their blood glucose, new research led by the University of Stirling has found.

Adding a food containing around 10g of protein to a high-glycaemic-load breakfast significantly improved blood glucose control after eating, helping young people spend more time within their target glucose range.

The researchers say adding a protein-containing food could offer a practical alternative to choosing lower-glycaemic-index (GI) breakfast foods, which cause blood glucose to rise more slowly, potentially allowing young people to continue eating foods they enjoy while improving their blood glucose control.

There are about 35,000 children and young people under the age of 19 with diabetes in the UK, and 96% per cent have Type 1.

Potential to help

The study was led by Dr Julie Johnson, who carried out the research while studying for a Doctorate in Professional Health Studies (Dietetics) at the University of Stirling.

Dr Johnson, who is Paediatric Dietetic Lead for NHS Highland, said: “These findings may offer a simple way to improve glucose management after breakfast in children and young people with Type 1 Diabetes. 

“Our study suggests that adding a small amount of a protein food to breakfast may help reduce the glucose spike that often occurs after eating breakfast cereals. This approach has the potential to help young people enjoy their preferred breakfast foods while achieving better glucose control.”

The study involved 25 children and young people aged five to 17 with Type 1 Diabetes, recruited through 13 diabetes centres across the UK. Participants used continuous glucose monitors to track their blood glucose for three hours after eating different breakfasts.

When young people ate a high-glycaemic-load breakfast without the additional protein, their average blood glucose over the three-hour period was 9.5 mmol/L (millimoles per litre, the unit used to measure blood glucose concentration). When the same type of breakfast was accompanied by a food providing around 10g of protein, average glucose fell to 8.0 mmol/L.

The change also meant young people spent around half an hour longer within their target blood glucose range. Participants were within range for an average of 132 minutes following the protein-added breakfast, compared with 100 minutes after the high-glycaemic-load breakfast.

The high-GI breakfast also caused a substantially larger peak rise in glucose. The average peak glucose excursion was 6.4 mmol/L, compared with 4.2 mmol/L after the protein-added breakfast.

The protein-added breakfast produced an overall glucose response like that seen following a lower-GI breakfast, suggesting that adding a modest amount of a protein-containing food could be another way of improving the response to a breakfast that might otherwise cause a significant glucose rise.

Practical advice

Professor Stuart Galloway of the University of Stirling’s Centre for Research and Innovation in Sport (CRIS), who is senior author of the paper, said: “This study evaluates some simple practical advice to add around 10g of protein intake at breakfast, showing that in the three-hour follow-up period this improved overall glycaemic control.”

The research builds on previous work by Dr Johnson which found that cereal-based breakfasts were the most common breakfast choice among children and young people with type 1 diabetes and were associated with the largest rises in blood glucose.

For the new study, participants could choose protein-containing foods including eggs, cheese and meat, or combinations of these.

The researchers stress that the improvement cannot be attributed to protein alone, because the foods also contained varying amounts of fat. The effect is likely to reflect the combined influence of protein and fat on the body's response to the meal.

There was no significant difference in the number of hypoglycaemic events between the different breakfast conditions during the three-hour follow-up, and the researchers found no evidence of delayed high blood glucose during this period.

However, they cannot rule out delayed hyperglycaemia occurring beyond three hours.

They conclude that larger studies should now be carried out to confirm the findings, examine longer-term effects and identify the most acceptable and less processed, lower-fat and lower-salt protein options for young people.

The study Protein-Containing Breakfasts Are Associated with Reduced Postprandial Glycaemic Excursions in Children and Young People with Type 1 Diabetes was published in Nutrients.