低碳饮食治疗内源性胰岛素缺乏糖尿病患者的临床研究  

Clinical Study on Low-carbon Diet for Endogenous-insulin-deficient Diabetes Patients

作　　者：顾蕴杰 宋静[2] 殷峻[1,2] GU Yunjie;SONG Jing;YIN Jun(Department of Endocrinology and Metabolism,Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital/Shanghai Clinical Center for Diabetes/Shanghai Diabetes Institute/Shanghai Key Laboratory of Diabetes Mellitus,Shanghai 200233,China;Department of Endocrinology and Metabolism,Shanghai Eighth People's Hospital,Shanghai 200235,China)

机构地区：[1]上海交通大学医学院附属第六人民医院内分泌代谢科,上海市糖尿病临床医学中心,上海市糖尿病研究所,上海市糖尿病重点实验室,上海市200233 [2]上海市第八人民医院内分泌代谢科,200235

出　　处：《中国全科医学》2023年第26期3308-3313,共6页Chinese General Practice

基　　金：国家自然科学基金面上项目(82070885);上海交通大学医学院高峰高原计划—“研究型医师”项目(20172025);上海市内分泌代谢疾病研究中心基金(2022ZZ01002);“振龙头”临床重点专科项目。

摘　　要：背景内源性胰岛素缺乏糖尿病患者的血糖控制情况通常较差,低碳饮食有利于糖尿病患者的血糖控制,然而鲜有关于低碳饮食治疗在内源性胰岛素缺乏糖尿病患者中的效果研究。目的探究低碳饮食治疗应用于内源性胰岛素缺乏糖尿病患者的疗效和安全性。方法选取2018年8月—2022年8月在上海市第八人民医院住院的80例内源性胰岛素缺乏糖尿病患者(空腹C肽≤0.5μg/L)为研究对象。依据患者在医院的就餐方式将患者分为普通饮食组(55例)和低碳饮食组(25例)。通过倾向性评分的方法将普通饮食组和低碳饮食组按照1∶1的比例进行配比,配对指标为年龄、糖尿病病程,卡钳值设置为0.3。对比两组患者住院第1天和出院时的血糖控制[包括平均血糖、变异系数(CV)、目标范围内时间(TIR)百分比、低于目标范围时间(TBR)百分比及高于目标范围时间(TAR)的百分比]、降糖药的使用(包括每日胰岛素注射次数及注射剂量、口服降糖药的种类)及不良事件的发生情况(发生糖尿病酮症酸中毒或低血糖的人数比例)。结果经过倾向性评分匹配后,普通饮食组和低碳饮食组分别纳入22例患者。低碳饮食组患者CV、TAR百分比均低于普通饮食组[CV(26.03±7.61)%与(33.79±12.46)%;TAR百分比(20.19±17.57)%与(30.43±15.74)%](P均<0.05),TIR百分比高于普通饮食组[(77.79±17.36)%与(67.05±17.59)%](P<0.05)。低碳饮食组每日胰岛素注射次数及剂量、口服降糖药种类均少于普通饮食组(P<0.05)。低碳饮食组和普通饮食组患者住院期间不良事件发生率[4例(18.2%)与5例(22.7%)]比较,差异无统计学意义(χ^(2)=0.140,P=0.709)。结论与普通饮食相比,低碳饮食有利于降低内源性胰岛素缺乏糖尿病患者的血糖变异性,延长TIR,减少降糖药物的使用而不增加糖尿病酮症酸中毒或者低血糖的风险。Background Glycemic control is usually poor in patients with endogenous-insulin-deficient diabetes,while low-carbon diets(LCD)are beneficial for glycemic control among patients with diabetes.However,few studies on LCD in patients with endogenous-insulin-deficient diabetes have been reported.Objective To investigate the efficacy and safety of LCD for patients with endogenous-insulin-deficient diabetes.Methods A total of 80 patients with endogenous-insulindeficient diabetes(fasting C-peptide≤0.5 ng/mL)who were hospitalized in Shanghai Eighth People's Hospital from August 2018 to August 2022 were selected as research subjects and divided into the control diet(CD)group with 55 cases and LCD group with 25 cases.The CD group and LCD group were matched by propensity score matching(PSM)in a 1∶1 ratio based on age and diabetes duration as matching indicators and caliper value as 0.3.The two groups of patients were compared in terms of glycemic control on the first day of hospitalization and at discharge,including average blood glucose,coefficient of variation(CV),percentages of time in range(TIR),time below range(TBR)and time above range(TAR);use of antidiabetic drugs,including the numbers and dosages of daily insulin injection and the types of oral antidiabetic agents;incidence of adverse events,including proportion of individuals who developed diabetic ketoacidosis(DKA)or hypoglycemia.Results After PSM,22 patients were included in the CD group and LCD group,respectively.The percentages of CV〔(26.03±7.61)%vs.(33.79±12.46)%〕and TAR〔(20.19±17.57)%vs.(30.43±15.74)%〕were lower in the LCD group than in the CD group(both P<0.05),the percentage of TIR〔(77.79±17.36)%vs.(67.05±17.59)%〕was higher in the LCD group than in the CD group(P<0.05).The numbers and dosages of daily insulin injection and the types of oral antidiabetic agents in the LCD group were significantly lower than those in the CD group(P<0.05).There was no significant difference in the incidence of adverse events(4 cases,18.2%vs.5 cases,22.7%)b

关 键 词：膳食 低碳水化合物 糖尿病 内源性胰岛素缺乏 血糖变异性 胰岛素 

分 类 号：R459.3[医药卫生—治疗学] R587.1[医药卫生—临床医学]