儿童1型糖尿病饮食干预及依从性研究

Dietary Intervene and Compliance Study for Type 1 Diabetes Mellitus of Children

目的:探讨儿童1型糖尿病饮食干预方案及其依从性。方法选取2013年11月~2014年5月我院儿科收治的26例儿童期1型糖尿病,按照儿科学糖尿病章节推荐能量计算公式,比照中国居民膳食指南各营养素推荐量制定饮食方案。同时记录每日三餐前后及夜间血糖和饮食完成情况。结果26例患儿中14例严格执行糖尿病餐,均无明显饥饿感。12例未严格执行糖尿病餐,2例因为临床医生建议减少主食量;1例因为糖尿病餐量超过平时摄入量无法完成;3例并无明显饥饿感,自行添加饼干等零食导致血糖控制不佳;6例因为睡觉、玩耍或挑食,家长未让患儿按时完成糖尿病餐,而另外换用其他食物导致当餐胰岛素无法执行或血糖不理想。所有患儿经过糖尿病餐,调整胰岛素用量以及家长教育,血糖最终均控制理想。入院初空腹血糖(12.2±2.5)mmol/L,餐后血糖(24.7±3.8)mmol/L;综合治疗后空腹血糖(4.3±0.8)mmol/L,餐后血糖(6.7±0.7)mmol/L。结论饮食营养治疗方案对于低龄1型糖尿病儿童具有较好的临床适用性。制约饮食干预实施的主要因素是家长和患儿的依从性,其次是临床医生对饮食干预的正确认识。

Objective To explore the dietary intervene and compliance for children with type 1 diabetes mel itus.Methods 26 children with type 1 diabetes mel itus aged from 9 months to 10 years and 2 months who were hospitalized from 2013 Nov to 2014 may were selected.According to the equation(energy perday(kcal)=1000+(80~100)í100)and Chinese residents dietary guidelines,the individual nutritional therapy was made.The daily blood sugar level before and after meals were recorded,in addition to the diet completion and the reason.Results 14 cases of the total 26 strictly enforced the nutritional therapy without obvious hunger feelings.In the other 12 cases,2 were advised by doctors to reduce the main meals to control the blood glucose level;1 felt too ful to finish it;the other 9 cases were al due to the noncompliance of the parents or the patients.After nutritional therapy and adjusting the insulin dosage,the fasting blood glucose and postprandial 2h blood glucose significantly decreased(12.2±2.5mmol/L vs 4.3±0.8 mmol/L,24.7±3.8 mmol/L vs 6.7±0.7 mmol/L respectively).Conclusion Individual nutritional therapy is applicable for children with type 1 diabetes mel itus.The related nutritional education to the children and their parents,as wel as the doctors,is the most important factors to ensure the completion of the nutritional therapy.