低血糖指数营养教育对2型糖尿病患者治疗效果的影响

目的:观察低血糖指数营养教育对2型糖尿病患者治疗效果的影响。方法:将156例2型糖尿病患者随机分为实验组和对照组各78例。实验组采用低血糖指数食物对患者进行营养教育,对照组给予常规饮食教育。两组均随访观察3个月,分别于就诊时与3个月后对两组患者进行相关生化指标测定,以观察治疗效果。结果:采用干预措施后,两组空腹血糖、餐后2h血糖、糖化血红蛋白、血清胆固醇、甘油三酯等生化指标均降低,但实验组与对照组相比效果更为明显(P<0.05)。结论:低血糖指数营养教育有助于增强2型糖尿病患者对糖尿病的认识,对控制和稳定血糖有积极意义。     

个体化营养膳食指导对2型糖尿病病人自我管理及血糖控制效果的影响

目的:探讨个体化营养膳食指导对2型糖尿病(T2DM)病人饮食管理能力及血糖控制效果的影响。方法:选取医院收治的糖尿病病人94例为研究对象,根据随机数字表法将病人分为观察组及对照组各47例,对照组行常规饮食指导,观察组实施个体化营养膳食指导,对比两组糖尿病认知水平、血糖控制水平及饮食管理能力的变化,记录两组血糖控制有效率、病人满意率及并发症发生率。结果:与对照组比较,干预后观察组饮食管理能力总分及相关维度评分明显升高(P<0.05);干预后观察组糖化血红蛋白(HbA1c)、空腹血糖(FBP)、餐后2 h血糖(2 hFBG)低于对照组(P<0.05);与对照组比较,观察组血糖控制有效率、遵医饮食依从率、满意率明显提高(P<0.05),并发症发生率明显下降(P<0.05)。结论:个体化营养膳食指导能有效提高T2DM病人饮食管理能力及饮食知识,提高病人饮食依从性,从而有效控制血糖,改善病人预后。     

158例中老年2型糖尿病患者社区营养干预研究

[目的]探索在社区中老年2型糖尿病(DM2)患者中进行营养干预对控制糖尿病并发症的发生和发展,提高患者生命质量的作用.[方法]对某社区已确诊的非住院DM2患者158例,采用配对设计分为干预组和对照组.干预组除给予药物治疗外还采取膳食指导、健康教育、营养干预等措施,对照组为单纯药物治疗.比较两组营养状况和生化检测指标.[结果]干预前两组病人三餐热能分配均不合理,营养状况不平衡.采取营养干预措施后干预组与时照组比较,营养缺乏和营养不平衡问题得到改善;血压、空腹血糖、餐后2 h血糖、糖化血红蛋白、血清胆固醇、甘油三酯、C-肽、尿微量蛋白等指标均有明显降低.[结论]社区DM2病人膳食结构不合理;营养干预对防治DM2效果明显;本干预模式可在社区推广.     

低血糖生成指数膳食在糖尿病临床治疗中的效果评价

[目的]观察低血糖生成指数(GI)食物营养干预对2型糖尿病病人血糖、血脂的影响,为其在防治2型糖尿病中的应用及推广低GI膳食模式提供科学的依据.[方法]将120例2型糖尿病病人随机分为观察组和对照组,每组60例,对照组采取一般治疗,观察组采取一般治疗结合营养干预.干预3个月后,比较两组病人干预前后低GI食物选择情况以及血糖、血脂的控制情况.[结果] 观察组病人干预后7类低GI食物的选择均有明显增加,其中6类明显高于对照组;观察组病人干预后血糖和血脂明显改善,均优于对照组.[结论] 低GI食物的营养干预可有效控制血糖,降低血脂,同时可产生明显的社会经济效益.     

肥胖2型糖尿病病人运用饮食处方干预的效果观察

[目的]观察肥胖2型糖尿病病人运用饮食处方干预的效果。[方法]将192例肥胖2型糖尿病病人随机分为对照组及观察组各96例,对照组给予常规的糖尿病健康教育及降血糖治疗,观察组在对照组基础上采用糖尿病营养软件进行饮食处方干预,并随访6个月,分别测量体重、身高,检测空腹血糖、餐后2 h 血糖及糖化血红蛋白等指标。[结果]观察组病人干预后空腹血糖、餐后2 h血糖、糖化血红蛋白、体重及体重指数均下降,且低于对照组(P <0.05)。[结论]肥胖2型糖尿病病人利用糖尿病营养软件进行饮食处方干预可减轻体重、改善血糖。     

综合护理干预对脑梗死合并糖尿病患者治疗效果的影响

目的探讨综合护理干预对脑梗死合并糖尿病患者治疗效果的影响。方法选择脑梗死合并糖尿病患者96例,随机分成两组,对照组（n=46）常规进行治疗护理;实验组（n=50）进行综合护理干预,包括由营养师根据患者情况提供营养治疗饮食,针对每位患者制订全面的护理计划和个体指导。对两组患者进行膳食调查及相关生化指标测定,以观察治疗效果。结果采用综合护理干预措施后,两组空腹血糖、餐后2h血糖、糖化血红蛋白、血清胆固醇、甘油三酯等生化指标均降低,但实验组与对照组相比效果更为明显;实验组的饮食结构更为合理。结论综合护理干预可以有效控制脑梗死合并糖尿病患者的血糖,对改善患者的临床症状,促进患者康复起到重要的作用。     

饮食护理干预对2型糖尿病肥胖病人的影响

[目的]了解糖尿病肥胖病人的身体状况和饮食情况,为糖尿病肥胖病人饮食护理干预提供依据。[方法]将153例2型糖尿病病人依据体重指数(BMI)分为肥胖组(BMI24.0kg/m2)107例和非肥胖组(BMI≤24.0kg/m2)46例,调查两组病人营养指标、生化指标及膳食营养摄取情况。[结果]肥胖组病人血压、血糖、糖化血红蛋白、三酰甘油高于非肥胖组,同时主食、肉类及盐的摄入量均高于非肥胖组,而蛋类、乳类及膳食纤维摄入量低于非肥胖组(P0.05)。[结论]应为糖尿病肥胖病人进行饮食护理干预,减少肉类、盐的摄入量,增加蛋类、乳类优质蛋白和膳食纤维的摄入量,加强对血糖、糖化血红蛋白、三酰甘油的控制。     

膳食结构调整在老年糖尿病患者饮食干预中的应用评价

目的探讨膳食结构调整在老年糖尿病患者饮食干预中的应用价值。方法应用前瞻性研究方法,对63例住院老年糖尿病患者进行饮食干预,统一在营养科定餐,遵循糖尿病饮食控制总热卡的原则,把水果和牛奶作为加餐,评价该组患者膳食结构调整的合理性,比较干预前后患者体质指数、低血糖发生率、血糖代谢指标的变化。结果干预后患者的膳食结构更加合理,体质指数达到正常范围,低血糖发生率较干预前降低,空腹、中餐后、晚餐后血糖较干预前降低。结论在老年糖尿病患者饮食干预中进行膳食结构调整,可改善患者营养状况,有效控制血糖。     

食物血糖生成指数概念用于2型糖尿病营养教育的效果观察

目的观察食物血糖生成指数概念用于2型糖尿病营养教育的效果。方法将179例2型糖尿病患者,按住院号尾数单双号分为观察组(86例)和对照组(93例)。对照组实施常规健康教育及食物交换份法饮食教育,观察组在对照组基础上增加食物血糖生成指数概念指导患者食物选择,制定个体化饮食治疗处方。比较两组患者营养教育的干预效果。结果观察组对饮食知识知晓率高于对照组(均P0.05),观察组餐后血糖水平低于对照组(P0.05)。结论食物血糖生成指数概念指导能有效提高糖尿病患者饮食治疗知晓率,降低餐后血糖水平。     

食物血糖生成指数在老年糖尿病病人饮食指导中的应用

[目的]探讨食物血糖生成指数(GI)饮食指导对老年2型糖尿病病人的影响.[方法]将46例老年2型糖尿病人随机分成观察组和对照组,观察组运用食物GI概念饮食模式,对照组按照一般糖尿病饮食疗法,比较两组的临床效果.[结果]两组病人饮食行为、血糖指标、体重指数、低血糖的发生率差异有统计学意义(P<0.05).[结论]运用GI概念指导老年糖尿病病人饮食,有利于端正病人的饮食行为、降低血糖、控制体重,降低低血糖发生率.     

低血糖指数肠内营养乳剂在急性脑卒中合并糖尿病患者中早期肠内营养的临床价值

【目的】探讨低血糖指数肠营养乳剂在急性脑卒中合并糖尿病患者中早期肠内营养的临床价值和意义。【方法】60例急性脑卒中患者,均有糖尿病史,随机分为低血糖指数肠内营养乳剂组（30例,0．9kcal／mL,A组）和高能肠内营养乳剂（TP-HE）高蛋白肠内营养制剂组[30例,1．5kcal／mL,高蛋白质含量（75g／1000mL）,B组],在相等热量[27kcal／（kg·d）]摄入条件下,进行28d不同血糖指数的肠内营养制剂治疗,比较两组糖尿病患者急性脑卒中时血糖的影响及蛋白支持的效果。【结果】A组第2、3、4周糖化血红蛋白（HbA1c）、鼻饲前半小时血糖（ABS）、鼻饲后2h血糖（PBS）值较B组低,有显著性差异（P〈0．05）;两组各营养相关指标比较无差异（P〉0．05）;A组d14尿路感染率,d28肺部感染率和尿路感染率较B组低,有显著性统计学差异（P〈0．05）,其余无显著性差异;两组NIHSS评分均无显著性差异（P〉0．05）;两组日常生活活动能力量表（ADL）评定和分级比较,均显示有显著性差异（P〈0．05）。【结论】低血糖指数肠内营养乳剂在急性脑卒中合并糖尿病患者中早期肠内营养具有更好的控制血糖效果,更低的感染率,而纠正低蛋白血症与高能高蛋白肠内营养乳剂无明显差异。     

Starchy foods and glycemic index

Different starchy foods produce different glycemic responses when fed individually, and there is some evidence that this also applies in the context of the mixed meal. A major reason appears to relate to the rate at which the foods are digested and the factors influencing this. A similar ranking in terms of glycemic response to specific foods is seen independent of the carbohydrate tolerance status of the groups tested. Potentially clinically useful starchy foods producing relatively flat glycemic responses have been identified. Many of these are considered ethnic or traditional and include legumes; pasta; grains such as barley, parboiled rice, and bulgur (cracked wheat); and whole-grain breads such as pumpernickel. Specific incorporation of these foods into diets has been associated with reductions in low-density lipoprotein cholesterol and triglyceride levels in hyperlipidemia and with improved blood glucose control in insulin-dependent diabetic patients. To facilitate identification of such foods, it has been suggested that the glycemic response should be indexed to a standard (e.g., white bread) to allow comparisons to be made between the glycemic index of foods tested in different groups of subjects. The scope of application of this principle is subject to further investigation. It may be used to expand the range of possibly useful starchy foods for trial in the diets of diabetic patients.     

Comparison of predictive capabilities of diabetic exchange lists and glycemic index of foods

To determine whether the diabetic exchange lists or the glycemic index of foods better predicts postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal, three test meals were developed and fed to 12 subjects with non-insulin-dependent diabetes mellitus (NIDDM) and 13 healthy subjects. Each test meal contained exactly the same exchanges (1 milk, 4 starch, 2 fruit, 2 meat, 3 fat, 1 vegetable). In one meal, foods of high glycemic index (GI) were used, in a second meal, foods of intermediate GI were used, and in a third meal foods of low GI were used. The total GIs of the meals were: high, 184; intermediate, 131; and low, 107, thus predicting responses to intermediate and low GI, which were 71 and 58%, respectively, of the responses to high GI. Although some of the observed differences in the glycemic responses to the test meals were statistically significant, primarily in healthy subjects, the differences were usually much less than predicted by the GIs of the meals. In NIDDM subjects, peak postprandial plasma glucose, plasma glucose area, plasma glucose area increment, and mean plasma glucose responses after intermediate and low GI were greater than 90% of the corresponding responses to high GI. In healthy subjects, only the plasma glucose area increment after the low-GI meal was close to the predicted response. High GI produced significantly greater insulin responses than low GI in healthy subjects. We conclude that the diabetic exchange lists more accurately predict postprandial responses to carbohydrate-containing foods eaten as part of a mixed meal than does the GI of foods.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sweeteners and beta-glucans improve metabolic and anthropometrics variables in well controlled type 2 diabetic patients

The introduction of fat and carbohydrates replacers has been a revolutionary advance in treating obesity and diabetes mellitus. Since these materials have shown to have beneficial effects on the metabolic profiles of diabetic patients, they should be useful in designing specific foods for patients with diabetes. OBJECTIVE: To compare metabolic and anthropometric improvements elicited by a diet based on the American Diabetic Association's nutrition recommendations with a modified, low-energy diet incorporating fat replacers and non-sucrose sweeteners. DESIGN: A total of 16 male, well controlled type 2 diabetes patients were divided into two groups of eight; one group received the diet based on the American Diabetic Association's nutrition recommendations, and the other was fed a modified, low-calorie diet containing a fat replacer (beta-glucans derived from oats) and the sweeteners, sucralose and fructose. Both groups were maintained on their respective diets for 4 weeks. All patients performed daily aerobic exercise consisting of walking for 60 minutes. Body weight, body mass index, basal glycemia, hemoglobin HbA1C, and lipid profile were determined in each patient before starting the diets and after 4 weeks of dietary intervention. RESULTS: Both diets produced significant improvements in weight, body mass index, lipid profile, basal glucose, and HbA1C. However, the experimental diet was superior to the American Diabetic Association's diet in improving metabolic and anthropometric profile: greater increase in HDL cholesterol and larger decreases in HbA1C, weight, and body mass index. CONCLUSIONS: A diet incorporating a fat replacer and non-sucrose sweeteners produced a greater improvement in metabolic and anthropometric variables in well controlled type 2 diabetic patients when compared with a diet based on American Diabetic Association's nutrition recommendations.     

糖尿病患者对食物血糖生成指数知识的接受性及膳食调整

背景: 血糖生成指数是含碳水化合物食物的生理学特征性指数, 食物血糖生成指数在糖尿病、心血管病和肥胖等慢性病的预防控制中具有重要的应用价值和实际意义。目的: 了解与传统的食物交换表为主要宣传材料的教育方法相比较, 糖尿病患者对食物血糖生成指数知识的接受性和实际意义。设计: 对比观察实验。单位: 中国疾病预防控制中心营养与食品安全所。对象: 选择 2000- 10/2002- 02 在北京市第六医院内分泌科就诊的糖尿病患者 72 例, 年龄 18～70 岁, 平均 58 岁, 男女各半。方法: 将 72 例糖尿病患者随机分为 2 组: ①血糖生成指数组: 以不同食物的血糖生成指数为主要教育材料。②食物交换表组: 以传统的食物交换表为主要教育材料。采用课堂讲座、个别辅导、电话咨询等方式教育 5个月。观察教育前后糖尿病患者对所授知识的知晓率、食物选择和血糖变化等。主要观察指标: 教育前后营养教育知识知晓率、空腹血糖及餐后 2 h 血糖变化。结果: 纳入糖尿病患者 72 例, 均进入结果分析。①患者教育后对各个问题的正确回答率明显高于教育前(P < 0.01)。教育前, 血糖生成指数组对血糖生成指数问题正确回答率低于食物交换表组对食物交换表问题的正确回答率(0, 6.5%, P < 0.01); 教育后, 血糖生成指数组对血糖生成指数问题正确回答率高于食物交换表组对食物交换表问题的正确回答率(92.2%, 79.4%, P < 0.01)。而对相同问题的平均正确回答率, 两组间差异不明显(P > 0.05)。在谷类食物的种类及制作方法、水果类、豆类及其制品的选择上, 血糖生成指数组均优于食物交换表组(P < 0.01) 。②两组教育后空腹血糖和餐后 2 h 血糖均低于教育前(P < 0.01) , 但组间比较, 差异不明显(P > 0.05) 。结论: 在糖尿病营养教育中, 患者对血糖生成指数知识的接受性优于食物交换表知识。     

基于血糖负荷概念的食物交换份法饮食干预对妊娠期糖尿病孕妇的影响

[目的]探讨基于血糖负荷概念的食物交换份法饮食干预对妊娠期糖尿病的影响.[方法]选择2012年5月-12月门诊常规产前检查,诊断为妊娠期糖尿病的孕妇158例作为研究对象,随机分为观察组（78例）和对照组（80例）,对观察组进行基于血糖负荷概念的食物交换份法饮食指导,对照组采用传统的饮食指导.[结果]治疗前两组孕妇的空腹血糖及餐后2h血糖比较差异均无统计学意义（P＞0.05）;治疗后两组孕妇的空腹血糖及餐后2h血糖比较差异均有统计学意义（P＜0.05）;血糖控制满意率比较差异有统计学意义（P＜0.05）,低血糖的发生率比较差异无统计学意义（P＞0.05）.孕妇的体重增加、体重指数变化和新生儿出生体重比较差异有统计学意义（P＜0.05）.[结论]血糖负荷的食物交换份法饮食干预,与传统的食物交换份法饮食干预进行比较,可以较好地控制孕妇孕期血糖和孕期体重的增加,降低母婴并发症,改善围生期结局.     

老年2型糖尿病患者急性心肌梗死早期血糖波动与心功能关系

目的探讨因急性心肌梗死住院的老年2型糖尿病患者入院早期血糖波动程度和心功能受损及恢复的关系。方法采用动态血糖监测系统测定88例老年2型糖尿病并急性心肌梗死患者早期血糖水平,根据平均血糖波动幅度分为血糖波动正常组（NGF组）18例、轻微血糖波动组（MGF组）30例和严重血糖波动组（SGF组）40例,评估3组入院时与3个月后心功能状态和超声心动图指标。结果人院时MGF组左室射血分数明显低于NGF组（P〈0．01）,左心室收缩末期容积明显高于NGF组（P〈0．01）;人院时及3个月后,SGF组KillipⅡ级及以上比例、左心室收缩末期容积和室壁运动积分指数均明显高于NGF组和MGF组,左室射血分数均明显低于NGF组和MGF组（P〈0．05）;3个月后NGF组和MGF组左室射血分数明显高于入院时（P〈0．01）,2组比较差异无统计学意义（P〉0．05）;SGF组超声心动图指标与治疗前比较差异无统计学意义（P〉0．05）。结论老年2型糖尿病患者心肌梗死早期易出现血糖异常波动,其中严重血糖波动的患者心功能受损更严重,且不易恢复。     

Effect of antecedent glucose control on cerebral function during hypoglycemia

OBJECTIVE: The incidence of both severe and asymptomatic hypoglycemia is increased threefold in intensively treated diabetic patients. To examine whether this reflects cerebral adaptation to low blood glucose levels, we investigated the effect of preceding glycemic experience on hormonal, EEG, and evoked potential responses to experimentally induced hypoglycemia with the slow-fall clamp. RESEARCH DESIGN AND METHODS: Three groups were examined: well-controlled diabetic patients and patients with insulinoma (group 1), poorly controlled diabetic patients (group 2), and nondiabetic subjects (group 3). RESULTS: The glucose threshold for epinephrine release was lower in group 1 (2.3 +/- 0.1 vs. 3.0 +/- 0.3 and 3.1 +/- 0.1 mM, P less than 0.02), and the peak epinephrine response was reduced (1.29 +/- 0.36 vs. 5.48 +/- 1 and 5.62 +/- 1.2 nM, P less than 0.01) compared with groups 2 and 3, whereas symptoms were not perceived until a lower blood glucose level had been reached (2.0 +/- 0.2 vs. 3.3 +/- 0.4 and 2.6 +/- 0.2 mM, P less than 0.01). Other counterregulatory responses were similarly delayed and diminished. In contrast, EEG changes that were compatible with hypoglycemia were detected in all subjects in group 1 (blood glucose 1.9 +/- 0.1 mM) but in only two in group 2 and none in group 3, despite similar blood glucose nadirs. CONCLUSIONS: The glycemic threshold for hormonal responses to hypoglycemia falls in individuals with intensively treated diabetes or insulinomas, but these patients are more likely to develop EEG abnormalities during hypoglycemia. This disparity helps explain the increased vulnerability of intensively treated patients to severe hypoglycemia.     

牙周干预对2型糖尿病伴牙周炎患者血糖控制及血清C反应蛋白的影响

[目的]探讨牙周干预对2型糖尿病伴牙周炎患者(type 2 diabetes mellitus with chronic periodontitis,DMCP)的牙周状况、血糖控制及血清C反应蛋白(C-reactive Protein,CRP)水平的影响.[方法]选择DMCP患者102例,随机分为两组:试验组52例(A组),给予牙周干预;对照组50例(B组),不予牙周干预.将A组患者按照其血糖控制情况再分为血糖控制较好28例(A1组)和血糖控制不佳24例(A2组).比较每组患者治疗前及治疗后1周、1个月、3个月的牙周探诊深度(probing depth,PD)、附着丧失水平(clinical attachment loss,CAL)、菌斑指数(plaque index,PLI)、龈沟出血指数(bleeding index,BI)、空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(Glycated hemoglobin A1c,HbA1c)及CRP水平.[结果]牙周治疗后3个月,A组患者牙周状况显著改善(P<0.05);治疗后3个月时,A2组患者HbA1c明显改善(P<0.05);而A1组HbA1c治疗后下降不明显(P>0.05).A组FPG和CRP水平在干预后1周后显著增高(P<0.05),但在1个月和3个月时显著降低(P<0.05).[结论]牙周干预可改善DMCP患者牙周临床指数及血糖控制情况,FPG和CRP也显著降低.