越来越多忙碌的美国人每天不吃早饭，一直到午餐时间才进食。这种不吃早饭的流行趋势与肥胖和心血管疾病的发生逐年增长有很大关联，而不吃早饭可能会给糖尿病人带来更大的健康风险。近日，相关研究结果发表在国际学术期刊diabetes care上。
在以色列特拉维夫大学的研究人员进行这项研究之前，很少有人知道不吃早饭究竟会对糖尿病病人的健康带来什么样的影响。他们发现2型糖尿病病人饥饿到中午再进食会触发餐后高血糖症，并对病人一整天的胰岛素应答情况造成损伤。
早餐--糖尿病病人最重要的一顿饭？
"尽管许多研究表明高热量早餐对于减轻体重和调节血糖代谢大有益处，但人们对于不吃早餐会对一整天的餐后血糖峰值带来什么样的影响了解甚少。特别值得注意的是，对于2型糖尿病病人来说，经常不吃早饭会造成全天的血糖峰值和HbA1C显著升高。" Jakubowicz教授这样说道。
在这项临床研究中，研究人员对平均年龄在56.9岁，平均BMI为28.2kg/m2的22名2型糖尿病病人进行了观察，在两天时间里，所有病人每天摄入相同数目的卡路里以及相同的平衡餐食，但在第一天的时候，病人正常进食早餐，而在第二天他们要饥饿到午餐时间才可以进食。结果表明，病人如果不吃早餐，其午餐和晚餐后血糖峰值分别高达268mg/dl和298mg/dl，而正常进食早餐，其午餐和晚餐后血糖峰值只有192mg/dl和215mg/dl。
提高beta细胞"记忆"
研究人员指出，从前一天晚上到第二天中午之间间隔的时间过长，产生胰岛素的胰岛beta细胞失去了"记忆"，因此在午餐之后beta细胞需要更多的时间恢复"记忆"，这引起餐后胰岛素应答出现延迟并导致一整天的血糖水平都出现异常升高。另外一个可能的原因是，饥饿到午餐时间会增加血液中脂肪酸水平，降低了胰岛素下调血糖水平的作用效率。
综上所述，吃早餐对于2型糖尿病病人来说非常重要，不吃早餐会引起全天餐后血糖峰值显著增加，影响糖尿病病人的血糖控制。一句话：再忙也要吃早餐。
Fasting Until Noon Triggers Increased Postprandial Hyperglycemia and Impaired Insulin Response After Lunch and Dinner in Individuals With Type 2 Diabetes: A Randomized Clinical Trial
Daniela Jakubowicz1,2, Julio Wainstein1, Bo Ahren3, Zohar Landau1, Yosefa Bar-Dayan1 and Oren Froy
OBJECTIVE Skipping breakfast has been consistently associated with high HbA1c and postprandial hyperglycemia (PPHG) in patients with type 2 diabetes. Our aim was to explore the effect of skipping breakfast on glycemia after a subsequent isocaloric (700 kcal) lunch and dinner.
RESEARCH DESIGN AND METHODS In a crossover design, 22 patients with diabetes with a mean diabetes duration of 8.4 ± 0.7 years, aged 56.9 ± 1.0 years, BMI 28.2 ± 0.6 kg/m2, and HbA1c 7.7 ± 0.1% (61 ± 0.8 mmol/mol) were randomly assigned to two test days: one day with breakfast, lunch, and dinner (YesB) and another with lunch and dinner but no breakfast (NoB). Postprandial plasma glucose, insulin, C-peptide, free fatty acids (FFA), glucagon, and intact glucagon-like peptide-1 (iGLP-1) were assessed.
RESULTS Compared with YesB, lunch area under the curves for 0-180 min (AUC0-180) for plasma glucose, FFA, and glucagon were 36.8, 41.1, and 14.8% higher, respectively, wheras the AUC0-180 for insulin and iGLP-1 were 17% and 19% lower, respectively, on the NoB day (P < 0.0001). Similarly, dinner AUC0-180 for glucose, FFA, and glucagon were 26.6, 29.6, and 11.5% higher, respectively, and AUC0-180 for insulin and iGLP-1 were 7.9% and 16.5% lower on the NoB day compared with the YesB day (P < 0.0001). Furthermore, insulin peak was delayed 30 min after lunch and dinner on the NoB day compared with the YesB day.
ConCLUSIONS Skipping breakfast increases PPHG after lunch and dinner in association with lower iGLP-1 and impaired insulin response. This study shows a long-term influence of breakfast on glucose regulation that persists throughout the day. Breakfast consumption could be a successful strategy for reduction of PPHG in type 2 diabetes.