上海市某社区2型糖尿病患者个体化及量化营养干预效果评价

The effects of nutrition intervention by the quantification and individualization on T2DM patients in a Community of Shanghai

目的探讨个体化和量化营养干预对2型糖尿病患者代谢及饮食结构的影响。方法采用随机抽样法,按入选条件选取上海市曹杨社区卫生服务中心55~75岁在册管理的106例2型糖尿病患者为调查对象,其中有94例完成研究,失访12例,失访率为11.3%,以居委会为基础分为对照组45例,干预组49例。干预组进行为期3月的个体化和量化营养干预和教育指导,制定个体化营养治疗方案,能量按照统一原则供给。教育手段包括一对一教育、分阶段集体教育及资料发放等。干预开始前后分别对受检者进行膳食调查、体格检查及实验室相关指标检测。结果经个体化和量化营养干预后,干预组体质指数[（23.65±3.23）kg/m2]较对照组[（25.19±2.68）kg/m2]有所下降,差异有统计学意义（P〈0.05）;空腹血糖[（6.39±2.89）mmol/L]、餐后2 h血糖[（9.89±6.42）mmol/L]、糖化血红蛋白[7.0（5.9~9.0）mmol/L]均较对照组[分别为（7.09±3.43）、（11.34±4.62）、7.2（6.5~9.0）mmol/L]明显下降,差异均有统计学意义（P〈0.05）;干预组健康饮食评分（health eating index,HEI）[（65.96±5.89）分]较对照组[（61.31±3.49）分]显著上升,差异有统计学意义（P〈0.05）。结论在社区糖尿病管理工作中,个体化和定量化营养干预可有效控制患者的血糖水平,改善患者膳食结构。

Objective To investigate the effects of nutrition intervention by the quantification and individualization on the metabolic and dietary structure of type 2 diabetes mellitus（T2DM） patients. Methods The stratified random sampling method was used to select 106 T2 DM patients（55-75 years old） from Caoyang community in Shanghai as the subjects. Among them, 94 cases completed the investigation and 12 cases dropped out, the dropout rate was 11.3%. Ninety four subjects were divided into control group（45 cases） and intervention group（49 cases）. The nutrition intervention by the quantification and individualization was performed in the intervention group for 3 months, including the education guidance, individualized nutrition therapy protocol and the united energy supply. Education contained a pair of education, collective education and information dissemination stages etc.The diet investigation, physical examination and laboratory tests were conducted in all subjects before and after nutrition intervention. Results After nutritional intervention, BMI（23.65±3.23） kg/m2 in intervention group was significantly lower than that（25.19±2.68） kg/m2 in control group（P〈0.05）; fasting plasma glucose（6.39±2.89） mmol/L, postprandial 2 h blood glucose（9.89±6.42） mmol/L and glycosylated hemoglobin A1C7.0（5.9~9.0） mmol/L in intervention group were significantly lower than those（7.09±3.43）,（11.34 ±4.62） and 7.2（6.5~9.0） mmol/L in control group（P〈0.05）; the healthy diet score（HDS） in intervention group was 65.96±5.89, which was significantly higher than that（61.31±3.49） in control group（P〈0.05）. Conclusion In diabetes management of the community, the nutrition intervention by the quantification and individualization could effectively control the blood glucose levels and improve the dietary structure of T2 DM patients.