食物血糖生成指数在妊娠期糖尿病营养教育中的应用

Application of glycemic index in nutritional education for pregnant women with gestational diabetes mellitus

目的通过营养健康教育，观察妊娠期糖尿病（gestatinoal diabetes mellitus，GDM）患者对食物血糖生成指数（glycemic index，GI）的接受程度、饮食行为改变，以及对血糖、母婴并发症发生率的影响。方法选择72例GDM患者作为研究对象，随机分为2组，实验组以食物GI为主要教育材料；对照组以食物交换份作为主要教育材料，采用集体讲座3次、随时电话咨询、当面答疑等方式教育至患者分娩前，观察教育前后研究对象对所授知识的接受程度、饮食行为改变、血糖变化、母儿并发症发生率。结果经过营养健康教育，GDM患者一致认为饮食治疗是控制血糖的首要基础，实验组接受教育后在选择食物方面，每餐选择低GI食物的百分率由13．8％提高到83．3％（P〈0.01），实验组教育后三餐食物G1分别为56．1±3．5，64．2±3．3，62．7±3．1，均较教育前明显下降（P〈0.01）。实验组和对照组教育后空腹血糖分别为（6．3±0．6）mmol／L，（7．6±1．3）mmol／L、餐后2h血糖分别为（7．2±0．9）mmol／L，（9．7±1．2）mmol／L，均较教育前有显著性下降[（空腹血糖：（9．2±1．6）mmol／L和（9．6±1．5）mmo／L；餐后2h：（11．1±1．6）mmol／L和（10．6±1．2）mmol／L，P〈0．01）]，但实验组血糖控制更理想。实验组手术产率为58．3％（23／36）、巨大儿出生率为2．7％（1／36）、胎儿窘迫发生率为5．5％（2／36），均低于对照组（分别为28、5、9例P〈0．05）。结论营养健康教育是控制血糖的有效手段；用食物GI知识来选择食物比用食物交换份法更容易控制血糖，效果更为理想，便于在医院门诊和社区教育中广泛推广和应用；建议可将食物GI与食物交换份相结合指导GDM患者更科学、更合理的安排每日膳食。

Objective To observe the acceptibility of glycemic index （GI）, diet changes in gestational diabetes mellitus（GDM） women and the effect of nutritional education on blood glucose sugar levels and the incidence of maternal and children complications. Methods Seventy-two GDM women were divided randomly into two groups. GI was used as educational material for the experimental group, while exchanging system of food was used for the control group. Health education was conducted by public lectures （3 times）, telephone and face to face consultation till the time of delivery. The effects of education, diet changes, blood glucose variations and the maternal and neonatal complications were compared before and after education. Results After the nutritional health education, all of the women believed that dietary therapy was the basis for blood sugar control. The percentage of subject who selected GI food for each meal in the experimental group increased from 13.8% before education to 83.3% after（P〈0. 01）. The GI in each meal every day after education was 56. 1 ± 3. 5,64. 2 ± 3.3,62. 7 ± 3.1, respectively, significantly decreased than those of before （P〈0. 01）. Fasting plasma glucose of the experiment and control group [（6.3±0. 6）mmol/L and （7. 6±1.3）mmol/L] and 2 h postprandial blood glucose [ （7.2±0. 9）mmol/L and （9. 7± 1.2）mmol/L] after education were much lower than those before education （P〈 0. 01）while the blood control of the experimental group was much better. The rate of operative delivery was 58.3 %, fetal macrosomia 2. 7%, and fetal distress was 5.5%, and all were significantly lower than those of control group （P〈0.05）. Conclusions Nutritional health education is the effective way for blood sugar control. Using the knowledge of GI to choose food is much easier to control blood sugar compared with food exchanging system. It can be applied widly in clinics and communities. We suggest GDM patients arrange their diets by combination of GI and food exchanging system which is more scientific and reasonable.