广东省成人1型糖尿病患者饮食及血糖管理现状调查

Current status of nutrient intakes and glycemic control in adults with type 1 diabetes mellitus in Guangdong Province

目的调查广东省成人1型糖尿病(T1DM)患者的饮食及血糖管理状况,评价结构化教育对T1DM患者的血糖控制和自我血糖管理水平的影响。方法2019年8月至2020年2月,从参与广东省1型糖尿病转化医学研究的中山大学附属第三医院及汕头大学医学院第二附属医院于2010年6月至2013年6月登记的成人T1DM患者中,纳入120例截至2019年12月已完整连续随访满5年的患者进行调查。对纳入患者进行最近3个月的食物频率问卷(FFQ)调查,并收集其临床资料。分析FFQ数据以获得患者饮食情况,并和《中国糖尿病膳食指南(2017)》推荐量进行比较,以糖化血红蛋白(HbA1c)评价血糖控制水平。采用t检验、配对t检验、方差分析、秩和检验和χ^(2)检验比较各定量和定性指标的差异。结果共纳入合格问卷114份,合格应答率为95%(114/120)。每日碳水化合物仅43.9%(50/114)的患者达到了指南推荐的水平,50.9%(58/114)的患者过量摄入脂肪,52.6%(60/114)的患者过量摄入蛋白质。患者膳食纤维的的摄入量为11.33(7.23,15.22)g,远远低于25~30 g的推荐量,达到指南推荐摄入量的患者仅有7.9%(9/114);部分维生素及矿物质摄入量均明显低于推荐水平,达到推荐水平的患者比例均明显低下。与GTT登记时结果相比,随访满5年的HbA1c值[分别为(8.87±2.33)%和(7.12±1.06)%]、血糖过高患者比例[分别为32.40%(36/111)和2.63%(3/114)]均显著下降,差异有统计学意义(P<0.01);HbA1c达标率[分别为23.42%(26/111)和51.75%(59/114)]、坚持每日自我血糖监测≥4次[分别为27.03%(30/111)和65.80%(75/114)]的患者比例均显著升高,差异有统计学意义(P<0.01)。结论目前广东省成人T1DM患者饮食质量低。低脂、高纤维、富含维生素及矿物质的食物应该作为T1DM患者健康饮食模式的重要组成部分。T1DM自我管理教育体系的结构化教育可能提高患者的自我管理水平。

Objective To investigate the status of nutrient intakes and glycemic control in adults with type 1 diabetes(T1DM)in Guangdong Province.And to evaluate the effects of structured education on glycemic control and self-management in patients with T1DM.Methods Food frequency questionnaires(FFQ)were performed on the adult T1DM patients who enrolled in two sites in different regions of Guangdong T1DM translational medicine study(GTT)from June 2010 to June 2013 and had been followed up for 5 years continuously by December 2019.Data on nutrient intakes and clinical information was collected.Glycated hemoglobin A1c(HbA1c)was used to evaluate whether or not glycemic target was achieved.The differences between two sites and different diet pattern were compared using t-test,paired-samples t-test,analysis of variance(ANOVA)test,rank sum test or chi-square test,where suitable.Results A total of 114 qualified questionnaires were included,and the qualified response rate was 95%(114/120).On average,43.9%(50/114)of the patients reached the recommended intake levels of carbohydrates.More than half of the patients had excessive intake of protein and fat[52.6%(60/114)and 50.9%(58/114),respectively].The intake of dietary fiber was 11.33(7.23,15.22)g,and the intake of some vitamins and minerals in all patients was significantly lower than the recommendation,and the proportion of patients meeting the recommended levels was pretty low.After 5 years of follow-up,the mean HbA1c[(8.87±2.33)%vs.(7.12±1.06)%]and the proportion of patients with hyperglycemia[HbA1c>9.5%,32.40%(36/111)vs.2.63%(3/114)]were significantly decreased,while the proportion of patients who achieved glycemic target[23.42%(26/111)vs.51.75%(59/114)]and who adhered to self-glucose monitoring at least 4 times a day[27.03%(30/111)vs.65.80%(75/114)]were significantly increased,when compared with the baseline results of GTT(P<0.01).Conclusions Current dietary quality of adults with T1DM in Guangdong Province was poor.Foods that are low in fat,high in fiber and vitamin and mineral-dense should be encouraged as important part of a healthy dietary pattern.As one of the self-management education systems,structured education may be associated with better self-management in T1DM.