Diabetes Care：低碳饮食对妊娠期糖尿病无效

　　根据《Diabetes Care》4月5日在线发表的一项研究结果，较少热量来自碳水化合物的饮食并不能减少妊娠期糖尿病患者对胰岛素治疗的需求，也不影响妊娠结局。

　　高级作者、西班牙Lleida大学的Didac Mauricio博士指出：“我们应当开始反思膳食糖负荷在妊娠期糖尿病治疗中的角色。而且，需要进一步研究妊娠期糖尿病的医学营养治疗(MNT)。”MNT是妊娠期糖尿病治疗的支柱，而且是以控制碳水化合物的量和分布为基础，被认为可在避免酮症的同时获得理想的血糖控制效果。

　　在西班牙，指南认为假如MNT不足以控制血糖水平就应当启动胰岛素治疗。然而，尚无随机对照试验证明预设碳水化合物份量的饮食具有减少胰岛素需求的作用。为此，研究者将152例妊娠期糖尿病患者随机分组，给予低碳水化合物饮食(40%的总热量来自碳水化合物)或对照饮食(含有55%的碳水化合物)。两种饮食均含20%的蛋白质。

　　低碳饮食组患者入组时的平均孕龄为30.4周，对照饮食组患者为30.1周。两组患者的平均年龄为33.5岁和32.1岁。共有130例患者完成了研究。

　　意向治疗分析显示，两组患者对胰岛素治疗的需求相似，累计胰岛素治疗率完全相同，均为54.7%(41/75)。按方案分析的结果与之相似：低碳饮食组的胰岛素治疗率为54.3%(38/70)，对照饮食组为55%(33/60)。

　　根据3天食物记录估算，研究者发现低碳饮食组的碳水化合物摄入量明显更低(P=0.0001)。两组在产科或围产期结局方面无显著差异。

　　Mauricio博士表示：“我们的试验首次显示出，碳水化合物供能百分比较低的饮食并不能减少对胰岛素治疗的需求，与此同时，这类饮食对妊娠结局也并无负面影响。不过，低糖负荷饮食可能仍然对某些女性有效，例如更加肥胖的女性。这有待于进一步研究。”

与糖尿病相关的拓展阅读：

• J Med Life：1型糖尿病合并抑郁者转归较差
• Australian Psychologist：精神健康状况可作为糖尿病自我监护指标
• MedPage：加拿大新指南称糖尿病患者40岁时应该使用他汀类药物
• MedPage：加拿大新指南称糖尿病患者40岁时应该使用他汀类药物
• Diabetes Care：维生素D缺乏不能预测糖尿病患者心血管风险 更多信息请点击：有关糖尿病更多资讯

Low-Carbohydrate Diet for the Treatment of Gestational Diabetes.A randomized controlled trial
OBJECTIVE
Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet.
RESEARCH DESIGN AND METHODS
A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed.
RESULTS
The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups.
CONCLUSIONS
Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes.