定量降低主食血糖负荷疗法在妊娠期糖尿病患者中的临床效果研究

Effect of Quantitative Control of Glycemic Load of Staple Foods on Patients with Gestational Diabetes Mellitus

目的探讨定量降低主食血糖负荷(GL)疗法在妊娠期糖尿病(GDM)患者中的临床效果。方法选取2016年3月—2017年6月在广州市第一人民医院营养科门诊就诊的GDM患者78例,随机分为对照组和试验组各39例;完成治疗的患者中,对照组33例,试验组35例。对照组采用一般营养疗法;试验组在对照组治疗的基础上采用定量降低主食GL疗法,均治疗4周。比较治疗前后两组患者总能量摄入、三大营养素(蛋白质、脂肪、碳水化合物)的供能比、总GL、单位能量GL、空腹血糖、餐后2h血糖、体质量增速及糖尿病营养知识评分。结果治疗前、后两组患者总能量和蛋白质、脂肪和碳水化合物供能比比较,差异无统计学意义(P>0.05)。治疗前两组患者总GL、单位能量GL、空腹血糖、餐后2h血糖水平比较,差异无统计学意义(P>0.05);治疗后试验组患者总GL、单位能量GL、餐后2h血糖水平低于对照组,差异有统计学意义(P<0.05);治疗后两组患者空腹血糖水平比较,差异无统计学意义(P>0.05)。治疗前两组患者体质量增速、糖尿病营养知识评分水平比较,差异无统计学意义(P>0.05)。治疗后试验组患者体质量增速低于对照组,差异有统计学意义(P<0.05);治疗后两组患者糖尿病营养知识评分比较,差异无统计学意义(P>0.05)。结论定量降低主食GL疗法可以较好地改善GDM患者的总GL、单位能量GL、餐后2h血糖水平、体质量增速。

Objective To investigate the effect of quantitative control of glycemic load（GL） of staple foods on patients with gestational diabetes mellitus（GDM）.Methods We enrolled 78 cases of GDM receiving treatment in the Nutrition Clinic,Guangzhou First People＇e Hospital during March 2016 to June 2017 and randomly divided them into the control group and experimental group.Both groups received the conventional nutrition therapy,the experimental group additionally received instructions about quantitative control of GL of staple foods.The interventions for both groups lasted for 4 weeks.Daily energy intake,percentage of energy supply of 3 major nutrients（protein,fat,carbohydrate）,total GL,GL of per unit of energy intake,fast blood glucose（FBG）,2 h postprandial blood glucose（2 hPG）,weight growth rate and diabetes-related knowledge scores in two groups were compared before and after dietary treatment.Results Except 10 （6 in the experimental group and 4 in the control group ） failed to complete the treatment,the other cases were included in the final analysis.（1）There was no significant difference in daily energy intake,percentage of energy supply from protein,fat or carbohydrate between two groups before and after dietary treatment（P〉0.05）.（2） Before treatment,there were no significant differences in total GL,GL of per unit of energy intake,FBG and 2 hPG between two groups,but after treatment,except FBG was still similar in both groups（P〉0.05）,the other 3 parameters decreased significantly in the experimental group（P〈0.05）.（3） Two groups demonstrated no differences in weight growth rate and scores in diabetes-related knowledge before intervention（P〉0.05）,but after intervention,although the scores in diabetes-related knowledge were similar in both groups（P〉0.05）,the weight growth rate was lower in the experimental group（P〈0.05）.ConclusionDietary intervention with quantitative control of GL of staple foods helps GDM patients reduce total GL,GL of per unit of energy intake 2 hPG effectively and weight growth rate.