中低热量饮食对超重和肥胖2型糖尿病患者治疗的影响

目的 探讨中低热量饮食对超重和肥胖的2型糖尿病(T2DM)患者体重和治疗的影响。 方法 将体重指数(BMI)≥25km·m~(-2)的T2DM患者454例随机分为A、B两组,在口服降糖药治疗的前提下,A组患者采用中低热量饮食,每日总热量约4621.16kJ(1150kcal);B组患者则采用普通DM饮食,每日总热量约7740.4kJ(1850kcal)。于治疗前后(0周,24周)测量患者的血压(BP)、体重并计算体重下降净值和下降百分数、空腹血糖、空腹胰岛素、HbA_1c、血脂谱和血尿酸、γ-谷氨酰转肽酶(GGT)和用药情况。结果 A组患者的体重、BP、口服降糖药用量明显低于B组(P<0.02),停药率明显高于B组(P<0.01);而且糖、脂蛋白和尿酸代谢的改善程度明显优于B组(P<0.05);空腹胰岛素和GGT也明显低于B组(P<0.02).A组患者治疗后,体重减轻百分数越多,患者的年龄越小,DM病程越短,各亚组间比较差异有显著意义(P<0.05);男女比值增加,BP降低值增多,各亚组间比较差异有显著意义(P<0.05);空腹血糖、HbA_1c、低密度脂蛋白、GGT和口服降糖药用量降低越多,各亚组间比较差异有显著意义(P<0.05);停药率升高越多,各亚组间比较差异有显著意义(P<0.02)。结论 中低热量饮食可降低超重和肥胖T2DM患者的体重,有助于代谢综合征的改善,并可减少口服降糖药用量。

The effects of the low-medium caloric diet on overweight or obese patients with type 2 diabetes mellitus

Objective To study the effects of the low-medium caloric diet and its weight loss on overweight or obese patients with type 2 diabetes mellitus. Methods 454 pateints of their BMI >25 kgm-2 with type 2 DM treated with oral antihyperglycemic agents (OAH) including metformin and sulfonylurea (SU, glibenclamide or glipizide or gliclazide) were randomly grouped into A and B. The patients of goup A were given low-mediun caloric diet (about 1 150 kcalday-1) while the patients of group B given general diabetic diet (about 1 850 kcalday-1). We tested all patients' blood pressure (BP), weight, fasting plasma glucose and insulin (FPG and FINS), HbAjC, triglyceride (TG) , low density lipoprotein (LDL) , high density lipoprotein (HDL) , blood uric acid (BUA) , and Gamma-glutamyltransferase (GGT) respectively at 0 wk and 24 wk and counted the dosage of their OAH at 24 wk. Results Group A patients' weight, BP, OAH dosage, FINS and GGT were lower than those of group B patients (P<0. 02), and their indexes of glycemia, lipoprotein and uric acid levels were ameliorated more greatly than those of group B (P<0. 05). Group A patients' effective rate for anti-diabetic drug (NDR) was higher than that of group B (P<0. 01). Among group A patients, their WLP(weight loss percentage) subgroups showed the following: when WLP increased more, then the patients were younger, the diabetic duration was shorter(P<0. 05), male to female ratio increased and BP decreased more (P<0. 05), the levels of FBG, HbA]C, LDL-C, GGT, and OAH dosages decreased more (P<0. 05), and OAH agents-stopping rates increased more (P< 0.02),with all the significant differences among the subgroups. Conclusions Low-medium diet can lower their weights of overweight and obese patient with type 2 DM, ameliorate their insulin resistance and decrease their OAH dosages.