能量缓释营养液防治夜间低血糖和改善胰岛素敏感性的研究

Supplement Energy Slow-releasing Nutritive Medium on Preventing and Curing Night Hypoglycemia and Improving Insulin Sensibility

目的通过临睡前补充能量缓释营养液观察其对药物继发性失效的2型糖尿病病人夜间低血糖和清晨反应性高血糖的影响及其对胰岛素敏感性的改善作用.方法按一定的要求选择2型糖尿病住院病人40例,按病人和家属的意愿分为普通糖尿病治疗饮食组(A组)和临睡前补充能量缓释营养液(益力佳SR)的糖尿病治疗饮食干预组(B组).A组在胰岛素治疗的基础上,进食普通糖尿病饮食定量治疗; B组的热能摄入量及三大产热营养素的供热比同A组,但提取100 kcal用益力佳SR替代作为临睡前点心,剩下的热量按照1/3、1/3、1/3的方式分餐摄取,持续14 d.两组病人每天都于22∶ 00,24∶ 00,3∶ 00,7∶ 00检测血糖,并观察夜间低血糖反应的发生率.分别于治疗前、干预后第7 d和干预后第14 d分别检测空腹血糖和空腹胰岛素,以观察胰岛素敏感性的变化情况.结果两组病人调整期3∶ 00的血糖、空腹血糖间差异均有显著性意义,A组不同时期胰岛素敏感性(ISI)间差异无显著性意义,B组第14 d ISI与干预前比较差异有显著性意义(P＜0.05),与A组比较差异有显著性意义(P＜0.05).B组第14 d的胰岛素分泌功能指数(IS)与第1 d比较差异有显著性意义(P＜0.05).结论临睡前补充相当于全日总热能5%～10%的营养液,可有效防治多次皮下胰岛素注射治疗糖尿病过程中夜间低血糖的发生,还具有一定的改善胰岛素分泌功能和胰岛素敏感性的作用.

Objective To observe the effect on type 2 diabetes mellitus the hypoglycemia during night and the hyperglycemia reactivel y at early morning, and the effect on the insulin sensibility by supplement ener gy slow-release nutritive medium before retiring.Methods 40 selected T2DM patients were divided into 2 group s according to supplement (group B) or not supplement (group A) the energy slow- release nutritive medium (100 kcal) before retiring for 14 days. During the 14 d ays, the overall study objects would be detected the blood glucose (BG) at time 22∶00, 24∶00, 3∶00, 7∶00, and observed t he incidence of night hypoglycemia. The overall study objects would be detected BG and insulin of fasting level and postprandial (after meal 2h) level at 1st, 7 th, 14th days, To calculate the insulin sensibility index (ISI ) and insulin sec retion function index (IS).Results In adjustment phase the BG at 3∶00AM of g roup A was lower significantly than that of group B (P<0.05), but the BG at 7∶00 AM was higher significantly than that of group B (P<0.05 ). To ISI and IS, there were no significantly change in group A. But in group B , both the ISI and IS have a significantly elevation at 14th days converses with the 1st day (P<0.05). The same was availability when conversed with grou p A.Conclusion That supplement energy slow-release nutritive me dium before retiring (equivalency 5%～10% of whole day must intake energy) can p revent and cure the incidence of night hypoglycemia in type 2 diabetes mellitus patients during poly-hypodermic injection of insulin therapy, and to some extent can improve the insulin secretional function and the insulin sensibility.