蛋白质前负荷进餐模式对1型糖尿病患者餐后血糖漂移的影响  

Impact of Protein Preload Meals on Postprandial Blood Glucose Excursions in Patients with Type 1 Diabetes Mellitus

作　　者：蔡芸莹[1] 李梦歌 张伦 李娟 苏恒[1] CAI Yunying;LI Mengge;ZHANG Lun;LI Juan;SU Heng(Department of Endocrinology,the First People's Hospital of Yunnan Province/the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China;Clinical Nutrition Department of the First People's Hospital of Yunnan Province/the Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China)

机构地区：[1]云南省第一人民医院,昆明理工大学附属医院内分泌科,云南省昆明市650032 [2]云南省第一人民医院,昆明理工大学附属医院临床营养科,云南省昆明市650032

出　　处：《中国全科医学》2023年第15期1880-1884,共5页Chinese General Practice

基　　金：云南省临床医学中心开放项目(2020LCZXKF-NM06,2019LCZXKF-NM03);云南省卫生和计划生育委员会医学领军人才培养项目(L-201624);云南省万人计划“名医”专项(YNWR-MY-2019-020)。

摘　　要：背景餐后血糖漂移是导致糖尿病患者糖化血红蛋白水平升高的主要原因,控制餐后血糖也是防治糖尿病慢性并发症的重要策略。目的评价蛋白质前负荷进餐模式对1型糖尿病(T1DM)患者餐后血糖漂移的影响。方法本研究为随机、开放、受试者内交叉的临床注册研究。选取2019年2月至2021年12月至云南省第一人民医院就诊的18~45岁、病程>1年的T1DM患者31例。所有患者在经过10 h禁食后,分别在进行动态血糖监测(CGM)的第4、7天,以完全相同的成分进食两次等热量的试验餐,进食模式分别为蛋白质前负荷餐和混合餐。使用动态血糖监测系统(CGMS)分析患者餐后5 h CGMS数据,包括餐后血糖峰值、餐后血糖达峰时间、平均血糖水平、血糖曲线下面积(AUC)、血糖增量曲线下面积(iAUC)、平均血糖波动幅度(MAGE)、血糖增量高峰(△Peak)、血糖增量低峰(△Low)、低血糖事件时间占比、高血糖事件时间占比等。采用广义线性混合模型比较两种进餐模式后餐后5 h血糖变化。结果共26例T1DM患者纳入统计分析。蛋白质前负荷餐和混合餐空腹血糖、血糖峰值、300 min平均血糖水平、180~300 min平均血糖水平、血糖>10 mmol/L时间占比、血糖>13.9 mmol/L时间占比、MAGE、△Peak比较,差异均无统计学意义(P>0.05)。蛋白质前负荷餐餐后血糖达峰时间、△Low高于混合餐,180 min平均血糖水平低于混合餐(P<0.05)。混合餐无低血糖事件发生。蛋白质前负荷餐餐后iAUC_(0~30)、iAUC_(0~60)、iAUC_(0~90)、iAUC_(0~120)、iAUC_(0~150)、iAUC_(0~180)、iAUC_(0~210)均低于混合餐(P<0.05)。蛋白质前负荷餐餐后0~30 min、31~60 min、181~210 min血糖偏移均低于混合餐(P<0.05)。结论蛋白质前负荷餐模式可改善成年T1DM患者的餐后血糖水平,降低餐后血糖变异性。Background Postprandial glucose excursions is the main cause of elevated glycated hemoglobin levels in patients with diabetes mellitus.Controlling postprandial glucose is also an important strategy for preventing and treating chronic complications of diabetes.Objective To evaluate the effect of protein preload meal pattern on postprandial glucose excursions in patients with type 1 diabetes mellitus(T1DM).Methods This study is a randomized,open-label,within-subject crossover clinical registration study.We selected thirty-one T1DM patients aged 18-45 years with a course of disease>1 year who were admitted to the First People’s Hospital of Yunnan Province from February 2019 to December 2021.After ten hours fasting,all patients ate two isocaloric test meals with the same ingredients,one is protein preload meals and another is mixed meals,on the 4th and 7th days of wearing continuous glucose monitoring systems(CGM),respectively.CGM was used to analyze the CGMS data 5 hours after a meal,including peak postprandial glucose,time to peak postprandial glucose,average blood glucose level;area under curve(AUC)for blood glucose,incremental area under curve(iAUC)for blood glucose,mean amplitude of glycemic excursions(MAGE),the incremental glucose peak(△Peak)and low(△Low),and the proportion of time of hypoglycemia and hyperglycemia events.We also used a generalized linear mixed model to compare the difference in blood glucose excursions during five hours post-prandial.Results Twenty-six T1DM patients were included in the statistical analysis.There was no significant difference in fasting blood glucose,peak blood glucose,mean blood glucose from 0 to 300 min,mean blood glucose from 180 to 300 min,the proportion of time when blood glucose>10 mmol/L(%),the proportion of time when blood glucose>13.9 mmol/L(%),MAGE,and △Peak between protein preload meals and mixed meals(P>0.05).The peak time and △Low of the protein preload meals were higher than those of the mixed meals,and the mean blood glucose(0-180 min)of the protein pr

关 键 词：糖尿病 1型 餐后血糖 血糖控制 食物与营养 蛋白质前负荷 血糖变异性 

分 类 号：R587.1[医药卫生—内分泌]