多种膳食纤维对2型糖尿病患者胰岛素抵抗的影响

Effect of multiple dietary ?bers on the insulin sensitivity of type 2 diabetes mellitus

目的评估多种膳食纤维对2型糖尿病患者胰岛素敏感性和胰岛β细胞功能的影响。方法选取2014年4月至2015年10月在本研究各分中心就诊的300例未采用胰岛素治疗的2型糖尿病患者,按照160∶80∶60的比例使用随机数字表法分组,多种膳食纤维组160例,单一膳食纤维组80例,对照组60例。对3组患者分别采取能量相似的3个月主食干预,多种膳食纤维组每日给予2个特膳馒头(多种膳食纤维),单一膳食纤维组每日给予2个全麦馒头(单一膳食纤维),对照组每日给予普通主食并于餐前冲服粉剂安慰剂(含4g低血糖指数糊精、0.7g茯苓、0.3g薏仁)。比较干预前后各组胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)、胰岛素分泌指数(homeostasis model assessment islet beta,HOMA-B)、空腹血糖、空腹胰岛素的变化。结果多种膳食纤维组124例、单一膳食纤维组63例、对照组43例患者完成3个月的干预和随访。干预前,单一膳食纤维组HbA1C高于对照组(P<0.05),其他指标3组差异无显著性(P>0.05)。干预后,对照组FPG较干预前上升,多种膳食纤维组FINS较干预前下降,多种膳食纤维、单一膳食纤维组HbA1C较干预前下降,差异均有显著性(P<0.05)。干预后,多种膳食纤维组HbA1C低于单一膳食纤维组,差异具有显著性(P<0.05)。干预前后,多种膳食纤维组HOMA-IR[M(Q1,Q3)]由3.01(1.89,5.19)降至2.89(1.57,4.30),干预前后差异有显著性(P<0.05);单一膳食纤维组由3.09(2.03,4.78)变为3.32(2.28,4.81),对照组由3.00(2.01,5.17)变为3.51(2.40,5.11),差异无显著性(P>0.05)。干预前后及各组间比较,HOMA-B均差异无显著性(P>0.05)结论多种膳食纤维可以改善未用胰岛素治疗的2型糖尿病患者的胰岛素抵抗情况。

Objective To evaluate the effect of multiple dietary fiber steamed bread on the insulin sensitivity and islet β cell function in type 2 diabctes mellitus(T2DM) patients.Method Patients with T2DM(without insulin therapy) in Beijing were enrolled from April 2014 to October 2015. Three type of staple food were given for 3 months: multiple dietary fibers steamed bread(n=124),wheat dietary fiber steamed bread(n=63) and common staple food(n=43). Two pieces of multiple dietary fibers or wheat dietary fiber steamed bread were given to the patients(containing similar energy). HOMA-IR, HOMA-β, fasting plasma glucose and insulin were compared between before and after intervention in every group. Result After 3 months intervention,the HOMA-IR [M(Q1, Q3)] reached a reduction from 3.01(1.89, 5.19) to 2.89(1.57, 4.3), in the multiple dietary fibers group,the difference is significant(P<0.05). HOMA-IR changed from 3.09(2.03, 4.78) to 3.32(2.28, 4.81) in the wheat dietary fiber group and from 3.00(2.01, 5.17) to 3.51(2.40, 5.11) in the common staple food group(P>0.05). Conclusion Multiple dietary fibers are effective in improving insulin sensitivity.