Preferred meal patterns in non-insulin-dependent diabetes

Current advice on the across-the-day distribution of energy and carbohydrate intakes in non-insulin-dependent diabetes (NIDD) is based on inadequate evidence. We have addressed this by a comparison of an even as opposed to a main evening meal pattern in 11 subjects with NIDD. Contributions of macronutrients to energy intake were fat 29%, protein 20% and carbohydrate 51% with each meal pattern. The peak glycaemic response in the morning was not as good as the response in the evening (P<0.01), where an even energy and carbohydrate spread was used; this contrasts with previous reports in healthy subjects where the morning response to glucose is better than that later in the day. This difference between peak morning and peak evening glycaemic response was not seen with a main evening meal. There was a lower overall glycaemic response with a main evening meal compared with an even meal pattern (P<0.01, by area comparison). The overall insulin response was not significantly different between the two meal patterns, although the sensitivity for insulin appeared better in the evening where there was an evening main meal.