薯蓣粥对妊娠期糖尿病患者血糖和胰岛素抵抗的影响

Effect of Yam Gruel on Blood Glucose Control and Insulin Resistance in Patients with Gestational Diabetes Mellitus

目的:观察薯蓣粥对妊娠期糖尿病(GDM)患者血糖和胰岛素抵抗(IR)的影响。方法:选取2019年7月—2020年12月在中国人民解放军联勤保障部队第九〇〇医院(总院区和仓山院区)和福建省立金山医院产科门诊确诊的GDM患者144例,采用SAS 9.4软件将GDM患者随机分为对照组和观察组,每组72例。对照组给予常规治疗和护理,主要包括定期门诊产检、饮食指导、运动指导、血糖自我监测和健康教育。观察组在对照组的基础上给予薯蓣粥,即在保持早餐摄入总热量不变的情况下,用薯蓣粥代替早餐中的碳水化合物[125 g去皮山药热量为70 kcal(1 kcal=4.186 kJ)],薯蓣粥于每天清晨服用,每周5次,连续服用10周。比较2组血糖指标[空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、糖化血红蛋白(HbA1c)]、胰岛素抵抗指标[空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)]、妊娠结局指标(妊娠分娩方式、妊娠不良结局)。结果:①血糖指标:与干预前比较,2组干预4、8、10周后2 h PBG均明显降低,2组干预10周后HbA1c均明显升高,差异具有统计学意义(P<0.05)。与对照组同一时间点比较,观察组干预8、10周后FBG均明显降低,干预后4、8、10周后2 h PBG均明显降低,干预10周后HbA1c明显降低,差异具有统计学意义(P<0.05)。②胰岛素抵抗指标:与干预前比较,对照组干预10周后FINS、HOMA-IR均明显升高,差异具有统计学意义(P<0.05);而观察组干预10周后FINS、HOMA-IR均无明显区别,差异无统计学意义(P>0.05)。与对照组比较,观察组干预10周后FINS、HOMA-IR均明显降低,差异具有统计学意义(P<0.05)。③妊娠结局:2组不良妊娠结局比较,差异无统计学意义(P>0.05)。结论:薯蓣粥可以有效改善GDM患者血糖和IR,但对妊娠结局的影响不明显,值得临床推广应用。

Objective: To explore the effects of yam gruel on blood glucose and insulin resistance in patients with gestational diabetes mellitus(GDM). Methods: A total of 144 patients with GDM were recruited from the Obstetric Department of 900 th Hospital of Joint Service Support Force of Chinese People’s Liberation Army(Center Hospital Area and Cangshan Hospital Area) and Fujian Provincial Jinshan Hospital from July 2019 to December 2020, which were randomly divided into the control group and the observation group, with 72 cases in each group. The control group was given routine treatment and nursing care including regular outpatient examination, diet guidance, exercise guidance, blood glucose self-monitoring and health education. The observation group was given yam gruel on the basis of the routine treatment and care in the control group. Yam gruel was used to replace the carbohydrates in the breakfast [125 g peeled yam, 70 kcal(1 kcal=4.186 kJ)] under the condition of maintaining the total calories of breakfast. The yam gruel was taken every morning, five times a week, continous treatment for 10 weeks. The difference of blood glucose indicators[fasting blood glucose(FBG), two-hour postprandial blood glucose(2 h PBG), glycosylated hemoglobin(HbA1 c)], insulin resistance indicators [fasting serum insulin(FINS), homeostasis model assessment insulin resistance index(HOMA-IR)], and pregnancy outcome indicators(delivery method, adverse pregnancy outcome) between two groups. Results:(1) Blood glucose indicators: compared with before intervention, 2 h PBG in the two groups after intervention for four, eight and ten weeks were significantly decreased, and HbA1 c in the two groups after intervention for ten weeks was significantly increased, the differences were statistically significant(P<0.05). Compared with the control group at the same time, the FBG of the observation group after intervention for eight and ten weeks was significantly decreased, the 2 h PBG of the observation group after intervention for four weeks, eight weeks and ten weeks was significantly decreased, and the HbA1 c of the observation group after intervention for ten weeks was significantly decreased, the differences were statistically significant(P<0.05).(2) Insulin resistance indicators: compared with before intervention, FINS and HOMA-IR in the control group after intervention for ten weeks were significantly increased, the difference was statistically significant(P<0.05), but the differences of FINS and HOMA-IR in the observation group after intervention for 10 weeks were not statistically significant(P>0.05). Compared with the control group, FINS and HOMA-IR in the observation group after intervention for ten weeks were significantly decreased, the differences were statistically significant(P<0.05).(3) Pregnancy outcomes: the difference of adverse pregnancy outcomes between two groups was not statistically significant(P>0.05). Conclusion: Yam gruel can effectively improve blood glucose and IR in patients with GDM, but the effect of improving pregnancy outcomes is not obvious,which is worthy of clinical application.