营养干预对2型糖尿病患者血糖水平影响及多因素Logistic分析

The Influence of Nutritional Intervention on the Level of Blood Glucose of the Patients with Type Two Diabetes Mellitus and Multiple Factors Logistic Analysis

目的:了解2型糖尿病住院患者的膳食摄入情况,分析比较医学营养干预前后患者膳食与生活方式对血糖水平的影响,为糖尿病患者膳食计划的制定提供依据。方法:采取多阶段分层列队研究的方法,选取医学营养干预的住院2型糖尿病患者284例,自制调查问卷对其干预前后膳食结构、空腹血糖(FPG)、餐后2小时血糖(2 h PG)、3个月后糖化血红蛋白比例(Hb A1c%)等指标的变化进行分析。结果:284例2型糖尿病住院患者单纯饮食控制(未服降糖药167例)调整前3大营养素构成比例为碳水化合物占63.56%,蛋白质占15.21%,脂肪占23.52%,饮食调整1个半月末FPG、2 h PG基本可调整到正常水平并能长期维持;服降糖药患者(117例)饮食调整前3大营养素构成比例分别为46.92%,20.05%和33.8%,进行饮食调整2个月末大部分患者FPG及2 h PG出现下降,3个月末基本达到正常水平。3个月末2组患者Hb A1c%均有明显变化(P<0.05);2型糖尿病住院患者谷类、蔬菜类、水果类、畜禽肉类、鱼虾类、油脂类摄入偏高;蛋类摄入合适;豆类、坚果、乳类摄入偏低。不良饮食习惯发生率方面:男性高于女性(P<0.01),年龄40岁以下、病程短、未接受饮食指导患者及超重患者是饮食干预的重点对象;多因素Logistic回归分析表明影响2型糖尿病患者血糖升高的危险因素依次为高糖饮食、超重、高血压、家族遗传史、抽烟、饮酒。结论:2型糖尿病住院患者膳食结构不合理,不良饮食习惯、营养摄入过剩等问题提示需要有针对性加强医学营养干预对2型糖尿病的防治意义重大,在血糖异常初期进行医学营养干预即可获得更好的卫生收益。

Objective： To provide the reference of establishing the diet plan of the patients with diabetes melli- ms （DM） by surveying the diet intake of the inpatients with type two diabetes mellitus （T2DM）, analyzing and com- paring the influence of diet and life style of the patients on the levels of blood glucose before and after nutritional in- tervention. Methods： All 284 inpatients with T2DM who received nutritional intervention were chosen by adopting multistage hierarchical queue study, the changes of diet structure, fasting plasma glucose（FPG）, two hours blood glu- cose （2 hPG） and HbA1c0% in three months of the patients were analyzed with selfmade questionnaires before and af- ter the intervention. Results： The proportions of three nutrients of 284 T2DM inpatients （167 patients didn＇t take an- tidiabetic drugs） were carbohydrate 63.56%, protein 15.21% and fat 23.52% before single diet control and adjust- ment, after adjusting the diet for one and a half month, FPG and 2 hPG could be adjusted to normal level and could be maintained for a long term; the proportions of three nutrients of 117 T2DM inpatients who take antidiabetic drugs （117 patients） were carbohydrate 46.92%, protein 20.05% and fat 33.8% before single diet control and adjustment, by the end of two months after adjusting the diet for, FPG and 2 hPG of most of the patients decreased and returned to normal level by the end of three months. By the end of three months, HbA1c% of both groups changed obviously （P〈0.05）; the intake of grains, vegetable, fruit, meat, fish and shrimp and oils for the inpatients with T2DM was high; the intake of eggs was proper; the intake of beans, nuts and milk was low. Male was higher than female re-markably in the incident of bad diet habits （P〈0.01）, overweight patients younger than 40 years, short course of the disease and who didn＇t accept diet are the important targets of diet intervention; the results of multiple factor Logistic regression analysis showed that the risk factors of affecting blood glucose of the patients with T2DM were high glucose diet, overweight, high blood pressure, family history, smoking and drinking. Conclusion： The inpatients with T2DM present the problems of improper diet structure, bad diet habits and excessive nutrients which need to be intervened by enhancing nutritional intervention, they show the significance of prevention and treatment of T2DM, and it could obtain better health benefits when the patients showing blood glucose abnormalities at early stage accept nutritional intervention.