Assessment of Breakfast Quality Index (BQI), Glycemic Index, Glycemic Load in Individuals Diagnosed with Type 2 Diabetes Mellitus Aged Between 35-60 Years

Abstract

India has seen an alarming rise in non-communicable diseases (NCDs), particularly type 2 diabetes mellitus (T2DM), driven by urbanization, dietary shifts, and sedentary lifestyles. While breakfast is often termed the “most important meal of the day,” the quality of this meal especially in terms of glycemic index (GI) and glycemic load (GL) has not been sufficiently studied in the Indian diabetic population. This study explored whether the quality and glycemic characteristics of breakfast could influence glycaemic control among middle-aged adults with T2DM. The primary objective of this study was to evaluate the breakfast quality, glycemic index (GI), and glycemic load (GL) of breakfasts consumed by individuals diagnosed with type 2 diabetes mellitus (T2DM) aged between 35 and 60 years. Specifically, the study aimed to assess breakfast quality using the Breakfast Quality Index (BQI), determine the GI and GL of breakfast meals through 24-hour dietary recall and examine their associations with key glycaemic markers namely fasting blood glucose, postprandial blood glucose, and HbA1c levels. Additionally, the study sought to explore potential correlations between breakfast composition and biochemical parameters, with the broader goal of understanding how breakfast quality and glycemic characteristics impact glycaemic control in individuals living with T2DM. A cross-sectional study was conducted among 60 adults (30 males, 30 females) aged 35-60 years, diagnosed with T2DM for at least six months. Participants were recruited from a diabetes specialty clinic in Mumbai. Breakfast quality, GI, and GL were assessed through validated dietary assessment tools. Anthropometric and biochemical parameters were collected from clinic records. Statistical analysis involved ANOVA and Pearson’s correlation using SPSS software. Participants were categorized based on glycaemic control: mildly elevated HbA1c (6.5-7%, n=19), moderately elevated (7.1-8%, n=26), and poorly controlled (8.1-9%, n=15). A progressive increase in mean weight and BMI was observed with worsening glycaemic control, though not statistically significant (p > 0.05). However, fasting glucose and postprandial levels were significantly higher in the poorly controlled group (165.00 ± 48.11 mg/dL and 250.00 ± 75.80 mg/dL, respectively; p < 0.001). Breakfast Quality Index showed a negative correlation with BMI (r = -0.354, p = 0.005), suggesting that better breakfast quality was linked with lower body weight. Though not statistically significant, higher BQI was also associated with lower fasting glucose (r = -0.236, p = 0.071) and postprandial glucose (r = -0.228, p = 0.082). Interestingly, BQI was positively correlated with GI and GL (r = 0.318 and r = 0.320 respectively, both p = 0.013), indicating that nutrient-dense breakfasts may still possess a high glycaemic impact depending on food composition. The findings suggest that breakfast quality, glycemic index, and glycemic load are important and interrelated dietary factors that may influence glycaemic outcomes in individuals with T2DM. While a higher BQI is linked to better metabolic profiles and lower BMI, it does not necessarily imply a lower glycaemic impact. This highlights the need for culturally tailored dietary guidelines that not only emphasize nutrient density but also carbohydrate quality for effective diabetes management in India.