低碳水化合物膳食对新诊断糖尿病患者能量及葡萄糖代谢的影响

Influence of Carbohydrate Restricted Diet on Energy and Glucose Metabolism in Newly Diagnosed Diabetic Patients

目的探讨低碳水化合物膳食对新诊断的糖尿病患者能量代谢及葡萄糖代谢的影响。方法选取新疆103团经口服葡萄糖耐量试验确诊的173例20岁以上新诊断的糖尿病患者,将其随机分为干预组和对照组,分别对其进行低碳水化合物和一般膳食治疗12个月。结果 (1)治疗结束时干预组达到低碳水化合物膳食摄入标准的人数比例为55.1%,糖化血红蛋白(HbA1c)<7.0%者占57.3%。(2)与对照组比较,干预组治疗前后体质量、腰围、体质指数、餐后血糖、HbA1c及血清总胆固醇(TC)下降得更多、摄入总能量、碳水化合物下降得更多,蛋白质增加,与对照组比较差异均有统计学意义(P<0.05)。两组患者低血糖发生率间差异无统计学意义(P>0.05)。(3)干预组体质指数≥25 kg/m2亚组与<25 kg/m2亚组间比较,治疗前后腰围、体质量下降更多,差异有统计学意义(P均<0.05),而对照组上述两亚组间仅体质量下降值间差异有统计学意义(P<0.05)。结论与一般膳食治疗相比,低碳水化合物膳食治疗能更好地控制新诊断糖尿病患者的总能量摄入,适度增加蛋白质摄入并改善能量代谢,降低其餐后血糖、HbA1c及血清TC;另外,还可改善超重/肥胖者的腹型肥胖。

Objective To evaluate the influence of carbohydrate restricted diet on the energy and glucose metabolism in newly diagnosed diabetic patients. Methods 173 people above 20 years old were diagnosed as diabetes mellitus by oral glucose tolerance test for the first time in 103 formation corps of Xinjiang. And they were randomly divided into intervention group and con- trol group, with each group given carbohydrate restricted diet and common diet treatment respectively for twelve months. Results （ 1 ） In intervention group, the proportion of patients achieving expectant standard of dietary carbohydrate intake was 55. 1%, and proportion of hemoglobin A1C （HbA1c） less than 7.0% was 57.3%. （2） Between the two groups there were statistically significant differences in the decrease of post - treatment body weight, waist circumference, body mass index, postprandial blood glucose, HbAlc, serum total cholesterol, dietary energy and carbohydrate intake and the increase in dietary protein intake （P 〈 O. 05 ） . There was no statistically significant difference in the proportion of patient suffering from hypoglycemia between the two groups （P 〉 0. 05） . （3） In intervention group, there were statistically significant differences in the decrease of post - treat- ment waist circumference and body weight between the two subgroups of body mass index less than 25 kg/m^2 and more than 25 kg/ m^2 （P 〈 0.05） , but only the decrease in body weight showed statistically significant difference between the above mentioned subgroups in control group （P 〈 0. 05） . Conclusion Compared with common diet group, carbohydrate restricted diet could control dietary energy intake more effectively and increase protein intake moderately among newly diagnosed diabetic patients, and it can also improve energy metabolism, reduce postprandial blood glucose, HbAlo and total cholesterol as well as lessen abdomi- nal obesity in overweight or obese patients.