短期极低热量限制饮食对2型糖尿病患者血糖和血脂代谢及降糖药用药剂量的影响

Effect of short-term and extremely low calorie restriction on glucose and lipid metabolism and dosage of hypoglycemic agents in patients with type 2 diabetes millitus

目的探讨短期极低热量限制饮食对2型糖尿病患者血糖、血脂代谢及降糖药用药剂量的影响。方法回顾性选择2017年1月至2018年1月合肥市第三人民医院收治的2型糖尿病住院患者共32例,采用短期极低热量限制饮食的方法,比较限食前后和限食后3个月患者体重、腰围、血糖、血脂指标及降糖药用药剂量的变化。结果限制饮食前、限制饮食后、限制饮食3个月后患者的体重分别为(70. 43±9. 32) kg、(68. 23±7. 52) kg、(66. 12±8. 34) kg,腰围分别为(90. 44±7. 43) cm、(87. 01±6. 63) cm、(85. 72±6. 09) cm。患者限制饮食后和限制饮食3个月后的体重和腰围显著低于限制饮食前;限制饮食前、限制饮食后、限制饮食3个月后患者的空腹血糖分别为(8. 12±2. 43) mmol/L、(6. 21±0. 98) mmol/L、(6. 44±1. 08) mmol/L,空腹胰岛素分别为(14. 34±3. 75)μU/L、(7. 84±2. 56)μU/L、(8. 11±2. 44)μU/L,HOMA-IR分别为(5. 18±1. 01)、(2. 16±0. 41)、(2. 32±0. 45),TC分别为(4. 98±0. 67) mmol/L、(4. 88±0. 67)mmol/L、(4. 90±0. 69) mmol/L,TG分别为(2. 87±0. 66) mmol/L、(1. 56±0. 34) mmol/L、(1. 66±0. 32) mmol/L,LDL-C分别为(4. 35±0. 78) mmol/L、(4. 25±0. 74) mmol/L、(4. 29±0. 71) mmol/L,HDL-C分别为(1. 10±0. 09) mmol/L、(1. 05±0. 08) mmol/L、(1. 07±0. 09) mmol/L。患者限制饮食后和限制饮食3个月后的血糖、空腹胰岛素和胰岛素抵抗指数(HOMA-IR)均显著低于限制饮食前;患者限制饮食后和限制饮食3个月后的血清甘油三酯水平显著低于限食前,其余血脂代谢指标无明显变化。8例使用胰岛素治疗的患者随访期间内胰岛素使用剂量显著降低[(18. 21±7. 44) U/d vs.(14. 43±4. 21) U/d,t=4. 434,P=0. 015]; 19例使用口服降糖药物的患者中4例(21. 95%)由2种口服降糖药物改为1种,3例(15. 79%)由使用1种降糖药物改为不使用降糖药物即能控制血糖。结论短期极低热量限制饮食可明显降低2型糖尿病患者的体重、腰围、空腹血糖和空腹胰岛素水平,并能明显减少患者的降糖药用药剂量,值得临床推广应用。

Objective To explore the effect of short-term very low calorie restriction on glucose and lipid metabolism and dosage of hypoglycemic drugs in patients with type 2 diabetes millitus.Methods A total of 32 patients with type 2 diabetes admitted to this hospital were retrospectively enrolled in this study.Short-term and extremely low calorie restriction was undertaken.The changes of body weight,waist circumference,blood level of glucose,blood lipid index and dosage of hypoglycemic drug in these patients before and after food restriction for 3 months were compared.Results The body weight of patients before diet restriction,after diet restriction for 3 months were(70.43±9.32)kg,(68.23±7.52)kg,(66.12±8.34)kg;and their waist circumferences were(90.44±7.43)cm,(87.01±6.63)cm and(85.72±6.09)cm respectively.The body weight and waist circumference of patients after food restriction for 3 months were significantly lower than those before food restriction;The fasting blood glucose of patients before and after diet restriction were(8.12±2.43)mol/L,(6.21±0.98)mol/L and(6.44±1.08)mol/L;levels of fasting insulin were(14.34±3.75)μU/L,(7.84±2.56)μU/L and(8.11±2.44)μU/L;HOMA-IR:(5.18±1.01),(2.16±0.41),(2.32±0.45);TC:(4.98±0.67)mmol/L,(4.88±0.67)mmol/L,(4.90±0.69)mmol/L;TG:(2.87±0.66)mmol/L,(1.56±0.34)mmol/L,(66±0.32)mmol/L;LDL-C:(4.35±0.78)mmol/L,(4.25±0.74)mmol/L,and(4.29±0.71)mmol/L;HDL-C:(1.10±0.09)mmol/L,(1.05±0.08)mmol/L,and(1.07±0.09)mmol/L.The blood glucose,fasting insulin and insulin resistance index(HOMA-IR)were significantly higher after the food restriction for 3 months.The serum levels of triglyceride after food restriction and 3 months after restriction were significantly lower than those before restriction,and the other lipid metabolism indicators did not change significantly.Eight patients received insulin therapy had significantly lower dosage of insulin during the follow-up period[(18.21±7.44)U/d vs.(14.43±4.21)U/d,t=4.434,P=0.015].Among 19 patients with oral hypoglycemic drugs,4 patients(21.95%)switched from 2 kinds of oral hypoglycemic drugs to 1 kind of drug,and 3 patients(15.79%)changed from using one kind of hypoglycemic drug to without using hypoglycemic drug.Conclusion Short-term extremely low calorie restriction can significantly reduce the body weight,waist circumference,fasting blood levels of glucose and fasting insulin in patients with type 2 diabetes,and significantly reduce the dosage of drugs in patients,hence it is worthy to be applied for clinical promotion.