低碳水化合物饮食和低脂肪饮食对2型糖尿病患者体质量及血糖的影响

Effects of A Low-Carbohydrate Diet and A Low-Fat Diet on Weight and Glycemic Control in Type 2 Diabetics Mellitus

目的比较低碳水化合物饮食和低脂肪饮食1年对2型糖尿病(T2DM)患者体质量及血糖的影响。方法采用随机对照的方法,将90例超重T2DM患者随机分为低碳水化合物饮食+双胍类药物治疗组(A组)和低脂肪饮食+双胍类药物治疗组(B组),各45例。A组患者给予低碳水化合物饮食+双胍类药物治疗;B组患者给予低脂肪饮食+双胍类药物治疗。分别在治疗前及治疗3、6、12个月检测两组患者的体质量、糖化血红蛋白(HbA1c)、血压和血脂。结果两组患者治疗前后体质量及高密度脂蛋白(HDL)水平变化比较,差异有统计学意义(P<0.01);而两组患者血压及血清总胆固醇(TC)、低密度脂蛋白(LDL)、三酰甘油(TG)、HbA1c水平变化比较,差异无统计学意义(P>0.05)。两组患者体质量明显下降及HbA1c的减少主要发生在治疗的前3个月,A组、B组体质量平均下降1.8kg/月和1.0kg/月,HbA1c均下降0.6%;但在1年里两组患者体质量减轻均为3.4kg。结论对于超重的T2DM患者,1年的低碳水化合物饮食及低脂肪饮食对HbA1c的影响类似,血压未受影响;但低碳水化合物饮食者体质量下降较低脂肪饮食者快,且较后者能显著提高HDL水平。

Objective To compare the effects of a 1 - year intervention with a low - carbohydrate and a low - fat diet on weight and glycemic control in patients with type 2 diabetes mellitus. Methods The randomized controlled clinical trial was taken to assign 90 overweight patients with type 2 diabetes mellitus to the low - carbohydrate diet （A） group and low＂ fat diet （B） group, with 45 patients in each. The patients in the group A were given a low - carbohydrate diet and biguanides; while those in the group B were given a low - fat diet and biguanides. The body weight, glycosylated hemoglobin （ HbAlc）, blood pressure and lipids were detected before treatment and 3, 6, and 12 months after the treatment. Results Before and after the treatment there were statistical differences in body weight and high density lipoprotein Cholesterol （ HDL - C） between the two groups （P 〈0. 01 ）; but no statistically significant difference was found in blood pressure, serum total cholesterol （TC）, low density lipoprotein Cholesterol （LDL- C）, serum triglyceride （TG） and HbA1 c （P 〉 0. 05 ）. The evident decreases of body weight and HbAlc of the patients in the two groups were mainly found at the first three months of treatment. The average decreases of body weight in group A and B were 1.8 kg/month and 1.0 kg/monih respectively; and the decreases of HbA1 c were both 0. 6%. Nevertheless, the decreases of weight in one year in both group were 3.4 kg. Conclusion For overweight patients with type 2 diabetes, a low - carbohydrate diet a low - fat diet for one year have similar effects on HBAlc, and no significant effect on blood pressure. However the low - carbohydrate diet produces a greater decrease than the low - fat diet; and the latter can obviously increase LDL- C level.