社区2型糖尿病患者HbA1c水平与营养状况的关系研究

Association of HbA1c level with nutritional status in community-based patients with type 2 diabetes

目的 探讨社区2型糖尿病患者HbA1c与营养状况的关系.方法 将219例社区2型糖尿病患者以HbA1c水平分为2组,HbA1c〈6.5%组108例、HbA1c≥6.5%组111例.分别比较两组的血压、血糖、血脂和胰岛素抵抗指数水平,以及膳食结构和营养素摄入情况.结果 （1）社区2型糖尿病患者HbA1c〈6.5%者占49.32%;（2）HbA1c与空腹血糖、餐后血糖、稳态模型评估的胰岛素抵抗指数（HOMA-IR）水平呈正相关（r分别为0.56、0.49、0.20,P〈0.05或P〈0.01）,与高密度脂蛋白胆同醇呈负相关（r=-0.16,P〈0.05）;（3）营养素摄入量与HbA1c的关系表现为：能量、碳水化合物、蛋白质和总脂肪是影响HbA1c的独立相关因素（均P〈0.05）;（4）与≥6.5%组相比,HbA1c〈6.5%组摄入较多水果.≥6.5%组纯能量类食物摄入过多,且蛋白质、总脂肪和饱和脂肪酸摄入量多于HbA1c〈6.5%组（P〈0.05）;（5）拟合线性回归模型发现：摄入较多粗粮杂豆、水果分别使HbA1c均值降低0.36%（P〈0.10）、0.46%（P〈0.01）;适量减少畜肉、油脂摄入量平均使HbA1c降低0.42%（P〈0.05）、0.37%（P〈0.10）.结论 目前社区2型糖尿病患者HbA1c〈6.5%者比例不高,HbA1c〈6.5%者与HbA1c〉≥6.5%者的营养状况差异明显,饮食对HbA1c的影响较大,因此应对2型糖尿病患者进行合理的饮食治疗,尽早实现糖尿病控制达标.

Objective To explore the possible correlation between HbA1c level and nutritional status in community.based patients with type 2 diabetes.Methods A totaI of 219 type 2 diabetes patients were assigned into 2 groups：one with HbAIc〈6.5%（n：108）and HbA1f≥6.5%（n=111）.Metabolic parameters,food components.and nutritional status were compared between 2 groups.Results （1）49.32% of the participants attained HbA1c〈6.5%.（2）HbA1c level was positively correlated with fasting plasma glucose,postprandial plasma glucose,and homeostasis assessment for insulin resistance（HOMA-IR）（r were 0.56,0.49,and 0.20,respectively,P〈0.05 or P〈0.01）,but negatively correlated with high-density lipoprotein-cholesterol（HDL-C）（r=0.16,P〈0.05）.（3）Linear regression analysis showed that energy,carbohydrate,protein,and fat were the independent risk factors of HbA1c（all P〈0.05）.（4）Patients with HbA1c〈6.5%consumed more fruits.The intake of pure energy-providing foods and protein-,fat-,or saturated fatty acid-rich foods were more frequent in patients with HbA1c≥6.5%（P〈0.05）.（5）The linear regression revealed that HbA1c level were decreased 0.36%（P〈0.10）or 0.46%（P〈0.01）by intake of more fruits,roughage and beans,and HbA1c levels were also decreased 0.42%（P〈0.05）or 0.37%（P〈0.10）by intake of less meat or oils.Conclusions In communitybased patients with type 2 diabetes mellitus,the incidence of HbA1c〈6.5% remains low,There exists great difference in nutritional status between the groups with high and low HbA1c levels.The impact of diet OB HbA1c level is great.It＇s necessary to emphasize the importance of diet therapy far better diabetes control.