Abstract 39: A study of the short-term effect of early dinner on fasting plasma glucose in habitual late eaters with uncontrolled type 2 diabetes mellitus

Background: In the urban setting, dinner is the main meal of the day and higher calories later at night may adversely affect glycemic control. We aimed to assess the effect of early dinner on glycemic control in habitual late eaters with uncontrolled T2DM in terms of fasting plasma glucose (FPG) levels and continuous glucose monitoring (CGMS) parameters. Methods: Prospective interventional crossover study recruiting participants from a tertiary care center. We included adult patients with uncontrolled T2DM (HbA1c 7-9% and either FPG 3140 mg/dl or post-prandial glucose 3 200 mg/dl) who habitually ate their last meal beyond 22:00 hrs, were on a stable lifestyle for the past 3 months and taking metformin and/or DPP4 inhibitors. Other anti-diabetic agents were excluded to avoid hypoglycemia. Late dinner (LD) and early dinner (ED) were defined as the last meal for the day beyond 22:00 hrs andbefore 20:00 hrs respectively. The patients ate LD for 4 days (Days 0-3) and ED for next 7 days (Days 4-10). Patients were admitted overnight for testing on days 0 (LD visit) and 10 (ED visit). Post-prandial (2 hrs post-dinner) and fasting (10 hrs post-dinner) samples were collected for glucose, insulin, lipid profile, hsCRP, IL-6 and malondialdehydelevels. A CGMS was applied for the entire duration and incremental area under curve (iAUC), average blood glucose (ABG) and glycemic variability were calculated. A labelled magnitude satiety scale (LMSS) was provided to document bedtime hunger. Results: 10 patients (7 males, mean age 52.5 years) with T2DM (mean HbA1c 7.54%, mean time of usual dinner 22:33 hrs) were recruited. FPG (119.8 ± 7.3 mg/dl vs 105.2 ± 5.7 mg/dl, P = 0.015), fasting insulin (15.0 ± 4.3 mcIU/ml vs 9.7 ± 2.7 mcIU/ml, P < 0.002) and total cholesterol (162.8 ± 13.4 mg/dl vs 145.6 ± 13.1 mg/dl, P = 0.029) reduced significantly in ED than LD. Post-prandial glucose and insulin and othermarkers did not change significantly. Among CGMS, 10 hr post-dinner iAUC (22587.9 ± 5168.3 mg/dlxmin vs 15886.3 ± 4288.7 mg/dlxmin, P < 0.002) [Figure 1], 10 hrABG (137.5 ± 9.3 mg/dl vs 125 ± 7.9 mg/dl, P < 0.002), 24 hr ABG (132.2 ± 7.5 mg/dl vs 124.8 ± 5.4 mg/dl, P = 0.037) and night meanamplitude of glycemic excursion (83.7 ± 5.8 vs 69.3 ± 7.5, P = 0.027) significantly reduced in ED than LD. The patients ate LD at meantime of 22:28 hrs and ED at meantime of 19:29 hrs. The LMSS showed significantly increased bedtime hunger on days 4 and 5 which reduced to baseline by day 10. Conclusion: This study shows that changing dinner timings without modification of other parametersimproves overall glycemic control, postprandial glycemic excursions, fasting glucose values, night time glycemic variability and insulin sensitivity in T2DM patients.