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Diabetologia:用混合闭环系统研究1型糖尿病成人餐后血糖控制的饮食决定因素

2021-11-16 从医路漫漫 MedSci原创

1型糖尿病患者,尤其是餐后血糖控制是一个挑战。碳水化合物(CHOs)是餐后葡萄糖反应(PGR)的主要决定因素。

   1型糖尿病患者,尤其是餐后血糖控制是一个挑战。碳水化合物(CHOs)是餐后葡萄糖反应(PGR)的主要决定因素。然而,越来越多的证据表明其他饮食成分(即蛋白质和脂肪)对PGR的影响。高摄入量的膳食蛋白质可能以剂量反应的方式增加PGR,可能是由于氨基酸转化为葡萄糖。此外,含有相同量CHO的膳食中脂肪的数量和质量可能通过延迟胃排空和降低胰岛素敏感性来影响PGR的形状和程度。升高血糖水平的进一步机制可能与蛋白质和脂肪刺激胰高血糖素有关。这引起了人们对单独使用CHO计数估算膳食胰岛素的有效性。本研究的目的是在混合闭环系统(HCLS)中评估1型糖尿病个体的膳食营养和餐后血糖反应(PGR)之间的关系。

方法:所有年龄为>18岁的1型糖尿病患者接受HCLS(最低670G;Medtronic MiniMed,美国)在Federico II Diabetes ologia University Hospital (Naples, Italy)的糖尿病门诊就诊,且至少有一个7天的饮食记录,观察期间每日食物摄入量>3350 kJ (800 kcal)和HCLS自动模式时间>97%符合研究条件。分析中包括的饮食记录是在2019年1月至2020年9月期间完成的,共1264顿饭(398顿早餐、441顿午餐和425顿晚餐)。所有的参与者都完成了一个或多个7天的食物日记,在得到了识别所吃食物的描述性信息和计算食物分量的指南之后。他们记录了所消费的所有食物和饮料(包括调味品),并根据家庭计量(杯子、勺子等)或体重报告了分量,提供了尽可能多的细节(如烹饪方法、品牌)。一位经验丰富的营养师与每位参与者讨论了食物记录,以检查潜在的错误和遗漏的信息。使用MetaDieta软件(meda, Ascoli-Piceno, Italy)计算能量摄入、营养成分、血糖指数和血糖负荷。参与者没有被要求在他们的饮食日记或CGM记录中报告身体活动的信息。然而,在观察期间,我们没有发现任何暂时性血糖指标的使用,这表明进行了一段时间的体育锻炼。通过25例1型糖尿病患者(12男13女,平均±SD年龄40±12岁,平均±SD HbA1c51±10 mmol/mol[6.9±0.2%])的7天饮食记录,评估其1264餐(398顿早餐、441顿午餐和425顿晚餐)的膳食组成。每顿饭6小时的PGR(连续葡萄糖监测指标,葡萄糖增量AUCs)和胰岛素剂量(餐前药丸,餐后由泵自动输送的微药丸和调整药丸)均进行评估。

结果:早餐、午餐和晚餐在能量、营养摄入量和胰岛素剂量方面存在显著差异。餐后血糖曲线显示在早餐后出现较早的峰值,直到午餐和晚餐后4小时才缓慢上升(p< 0.001)。早餐(79.3±22.2%)比午餐(71.3±23.9%)和晚餐(70.0±25.9%)的餐后平均时间(SD)好(p< 0.001)。早餐时TIR的显著负预测因子是总能量摄入、总蛋白质和单不饱和脂肪酸的摄入百分比、血糖负荷和胆固醇的绝对值、碳水化合物和单糖的消耗量(p< 0.05)。午餐时TIR未检测到显著的预测因子。对于晚餐时的TIR,一个显著的积极预测因子是植物蛋白摄入量的百分比,而负预测因子是血糖负荷和单糖和碳水化合物的摄入量(p< 0.05)。

图1 血糖浓度(实线,意味着±SE)和胰岛素剂量由泵自动作为餐后microboluses和调整丸由参与者根据hcl建议(垂直酒吧)早餐(n = 398) (a)、午餐(n = 4 4 1) (b)和晚餐(n = 4 2 5) (c)

图2 CGM早餐、午餐和晚餐都有指标。意味着±SD;*与早餐的p< 0.05(混合效应模型与事后Bonferroni多重比较检验)

表1 早餐、午餐和晚餐时膳食营养成分与血糖控制(TIR 3.9 - 10.0 mmol/l)的关系

表2 在餐后早期(0-3小时)和3 - 6小时,餐后营养成分和餐后胰岛素剂量(由泵自动提供的微丸加上参与者根据HCLS建议提供的调整丸)之间的关系

结论:本研究显示除碳水化合物量外的营养因素显著影响餐后血糖控制。这些营养决定因素在早餐、午餐和晚餐之间是不同的,对餐后血糖水平和胰岛素需求有不同的影响,因此对HCLS仍然是一个挑战。

原文出处:

Vetrani C,  Calabrese I,  Cavagnuolo L,et al.Dietary determinants of postprandial blood glucose control in adults with type 1 diabetes on a hybrid closed-loop system.Diabetologia 2021 Oct 23

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    2021-11-17 查查佳佳

    有年龄为>18岁的1型糖尿病患者接受HCLS

    0

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