体重正常的2型糖尿病患者一日食谱

【适用对象】适用于中等身材、体重正常、从事轻体力劳动的成年男性或一般体力活动的成年女性糖尿病患者。     

2型糖尿病患者体重指数与脂代谢的关系及意义的研究

目的研究2型糖尿病患者体重指数(BMI)与脂代谢异常之间的关系,指导临床调脂治疗.对象与方法将160例2型糖尿病患者根据体重指数分为4组,分别测定空腹血胆固醇(CH)、甘油三酯(TG)、高密度脂蛋白(HDL)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB).结果随BMI增加,TG水平明显升高,HDL逐渐降低(P＜0.05);ApoA呈下降趋势,ApoB呈增高趋势,CH略呈增高,但四组间相比均无显著差异(P＞0.05).结论2型糖尿病患者超重和肥胖均伴随脂代谢紊乱,以TG升高为主,临床治疗时应进行积极的调脂治疗.     

2型糖尿病双下肢动脉粥样硬化与BMI和腰围的关系

收集17名正常人，20名单纯肥胖患者，42名2型糖尿病患者的临床资料，以彩色血管多普勒超声探测受试者的双下肢股动脉、胭动脉、胫前动脉、胫后动脉及足背动脉，并测量内中膜最厚处厚度及斑块数目、管腔狭窄程度。结果①在2型糖尿病组动脉粥样硬化斑的阳性率显著高于正常组及单纯肥胖组（P值分别〈0．05及〈0．01），且内中膜厚度显著大于后二者（P值分别〈0．05及〈0．01）。2型糖尿病组较正常对照组及单纯肥胖组动脉损伤发生率高、程度重（P值分别〈0．05及〈0．01）。②2型糖尿病患者中，下肢动脉硬化与体重指数、腰围呈显著正相关（P〈0．01）。结论在本资料的2型糖尿病患者中，90％已有动脉粥样硬化，中心性肥胖对2型糖尿病患者动脉硬化有显著影响。     

青年和中年时期体重状态变化及最大体重减重程度与其中老年时期2型糖尿病的关系

目的探讨青年及中年时期人群,发生超重和肥胖后的体重状态变化以及最大体重减重程度与其中老年期发生T2DM的关系。方法基于中国糖尿病和代谢紊乱研究库,选取19878名年龄≥40岁的中老年人群,采用多因素Logistic回归分析既往超重及肥胖[最大BMI(BMIMax)≥24.0 kg/m^2]发生在青年及中年时期人群的体重状态变化及最大体重减重程度与T2DM患病风险的关系。结果与正常体重组(BMIMax及BMI 18.5~23.9 kg/m^2)相比,青年时期持续超重组(BMIMax及BMI≥24.0 kg/m^2)、青年时期既往超重组(BMIMax≥24.0 kg/m^2,BMI 18.5~23.9 kg/m^2)、中年时期持续超重组(BMIMax及BMI≥24.0 kg/m^2)、中年时期既往超重组(BMIMax≥24.0 kg/m^2,BMI 18.5~23.9 kg/m^2)的T2DM患病风险均不同程度增加,以青年时期持续超重组最高(OR 2.57,95%CI 2.21~2.99)。超重人群(BMIMax≥24.0 kg/m^2)中,与减重<5%人群相比,减重≥5%人群T2DM患病风险增高,以减重≥15%人群风险最高(OR 3.58,95%CI 3.07~4.17)。结论无论目前体重正常或超重,青年及中年时期人群发生超重及肥胖均增加其中老年时期T2DM患病风险。超重人群最大体重减重≥5%时,中老年T2DM患病风险增加。     

2型糖尿病双下肢动脉粥样硬化与BMI和腰围的关系

收集17名正常人,20名单纯肥胖患者,42名2型糖尿病患者的临床资料,以彩色血管多普勒超声探测受试者的双下肢股动脉、腘动脉、胫前动脉、胫后动脉及足背动脉,并测量内中膜最厚处厚度及斑块数目、管腔狭窄程度.结果①在2型糖尿病组动脉粥样硬化斑的阳性率显著高于正常组及单纯肥胖组(P值分别＜0.05及＜0.01),且内中膜厚度显著大于后二者(P值分别＜0.05及＜0.01).2型糖尿病组较正常对照组及单纯肥胖组动脉损伤发生率高、程度重(P值分别＜0.05及＜0.01).②2型糖尿病患者中,下肢动脉硬化与体重指数、腰围呈显著正相关(P＜0.01).结论在本资料的2型糖尿病患者中,90%已有动脉粥样硬化,中心性肥胖对2型糖尿病患者动脉硬化有显著影响.     

BARI 2D研究——一项治疗合并2型糖尿病的冠心病的随机研究

2型糖尿病的心血管事件发生率比非糖尿病患者要高。很少有大型的随机的试验提出这个问题——到底合并糖尿病的且经冠脉造影证实的缺血性心脏病患者的最佳治疗方案是什么？2型糖尿病中旁路血管成形术再血管化调查——一项治疗合并2型糖尿病的冠心病的随机研究（A Randomized Trial of Therapies for Type 2 Diabetes and Coronary Artery Disease,The BARI 2D Study Group,BARI 2D）的目的就是为了评价这类患者的治疗效果。     

最大体重与2型糖尿病发病关系的病例对照研究

目的探讨既往最大体重与2型糖尿病(T2DM)发病的关系,推论其与当前体重及胰岛β细胞功能和胰岛素敏感性的关系。方法178例T2DM家系患病-非患病同胞,其中T2DM97例,正常糖耐量(NGT)81例,评价胰岛素抵抗及胰岛β细胞功能,logistic回归分析既往最大体质指数(BMI)与T2DM的发病关系。结果两组既往最大BMI分别为27·6±3·8kg/m2和25·6±3·0kg/m2,差异有统计学意义(P=0·000);既往最大BMI与T2DM的发生呈正相关(OR=1·193,P=0·000);既往最大BMI与当前BMI显著正相关(P=0·000),T2DM组和NGT组的相关系数分别为0·861和0·867。随既往最大BMI的增加,血压、空腹胰岛素、胰岛素抵抗指数升高,胰岛素敏感性下降。结论既往最大BMI越大,T2DM发病危险性越大,当前体重也越大;超重或肥胖个体由于胰岛素敏感性下降导致T2DM发病的危险性增加。     

老年2型糖尿病女性代谢综合征与骨质疏松的关系

目的探讨老年2型糖尿病女性代谢综合征(MS)与骨质疏松(OP)的关系。方法 85例老年2型糖尿病女性分为OP组及非骨质疏松(non-OP)组,比较两组的基本情况、代谢组分及骨密度(BMD)。Pearson相关分析分析BMD与代谢组分的相关性。Logistic回归分析OP的影响因素。病人再分为MS组和非MS(non-MS)组,比较两组的BMD及OP患病率。结果 OP组较non-OP组的年龄、脉压(PP)、总胆固醇(TC)、尿酸(UA)、纤维蛋白原(Fg)高(P<0.05或P<0.01),而体重指数(BMI)、双股骨、L1⁴BMD低(P<0.05或P<0.01)。双股骨BMD与年龄、TC、Fg负相关,与BMI正相关;L14BMD低(P<0.05或P<0.01)。双股骨BMD与年龄、TC、Fg负相关,与BMI正相关;L1⁴BMD与年龄、TC、TG负相关,与BMI正相关。OP的影响因素为TC,PP,BMI。MS组和non-MS组的BMD及OP患病率的差别无统计学意义(P>0.05)。结论老年女性2型糖尿病的MS与OP的关系复杂,今后应围绕胰岛素抵抗在基础和临床方面进行两者关系的研究。     

Prevention of weight gain in type 2 diabetes requiring insulin treatment

Background: Patients with type 2 diabetes who are failing on oral agents will generally gain a large amount of body fat when switched to insulin treatment. This adverse effect may be related to chronic hyperinsulinism induced by long-acting insulin compounds.
Aim: To test the concept that regain of glycaemic control can be achieved without causing weight gain, using a regimen free of long-acting insulin.
Methods: In a 3-month open-label pilot study including 25 patients with moderate overweight and secondary failure, we investigated whether nocturnal glycaemic control could be achieved with glimepiride administered at 20:00 hours. The starting dose was 1–2 mg, with subsequent titration up to a maximum of 6 mg. Rapid-acting insulin analogues were used three times daily to regain postprandial glucose control.
Results: Glycaemic control at 3 months was established with glimepiride in a dose of 4.4 ± 0.3 mg/day (mean ± standard error of the mean), and a total daily insulin dose of 24.1 ± 2.6 IU. Fasting glucose levels decreased from 12.7 ± 0.6 mmol/l to 8.1 ± 0.3 mmol/l (p  <  0.001), and target levels were reached in 14 of 25 patients (56%). Mean HbA1c decreased from 10.5 ± 0.4 to 7.7 ± 0.2% (p  <  0.001). Symptomatic nocturnal hypoglycaemia was not reported. Body weight did not change (85.7 ± 3.6 kg vs. 85.7 ± 3.3 kg, p = 0.99).
Conclusion: The data suggest that this new approach may be useful in about 50% of type 2 diabetes patients presenting with failure on maximal oral treatment.     

Insulin treatment and the problem of weight gain in type 2 diabetes

PURPOSE: Insulin therapy has been shown to benefit the prognosis in patients with type 2 diabetes, but its initiation and intensification is often delayed through concerns about hypoglycemia and weight gain. In addition, weight gain is linked to the pathophysiology of type 2 diabetes and contributes to the overall risk for adverse cardiovascular outcomes. This article attempts to summarize this issue and examine the options available for weight management. METHODS: A broad range of literature has been reviewed to distill important, consistent facts about insulin and weight gain and the options available for limiting the problem. RESULTS: Unfortunately, the great benefits of insulin therapy may be potentially undermined by weight gain. Weight gain is physiologically and psychologically undesirable, especially in patients with diabetes who are already overweight. The fear of weight gain with some medications contributes to psychological insulin resistance, which may discourage patients from commencing or following insulin regimens. However, new diabetes treatments and lifestyle interventions can be used to mitigate these problems. CONCLUSIONS: The exact choice of insulin and oral medications and weight loss interventions are important considerations in the overall management of patients with type 2 diabetes. Changes in a patient's lifestyle, such as modifications to diet and implementing an exercise program, are first-line treatments for type 2 diabetes and can also counteract insulin-induced weight gain.     

Prospective study of dietary carbohydrates, glycemic index, glycemic load, and incidence of type 2 diabetes mellitus in middle-aged Chinese women

BACKGROUND: Much uncertainty exists about the role of dietary glycemic index and glycemic load in the development of type 2 diabetes mellitus, especially in populations that traditionally subsist on a diet high in carbohydrates. METHODS: We observed a cohort of 64,227 Chinese women with no history of diabetes or other chronic disease at baseline for 4.6 years. In-person interviews were conducted to collect data on dietary habits, physical activity, and other relevant information using a validated questionnaire. Incident diabetes cases were identified via in-person follow-up. Associations between dietary carbohydrate intake, glycemic index, and glycemic load and diabetes incidence were evaluated using multivariable Cox proportional hazards models. RESULTS: We identified 1,608 incident cases of type 2 diabetes mellitus in 297,755 person-years of follow-up. Dietary carbohydrate intake and consumption of rice were positively associated with risk of developing type 2 diabetes mellitus. The multivariable-adjusted estimates of relative risk comparing the highest vs the lowest quintiles of intake were 1.28 (95% confidence interval, 1.09-1.50) for carbohydrates and 1.78 (95% confidence interval, 1.48-2.15) for rice. The relative risk for increasing quintiles of intake was 1.00, 1.04, 1.02, 1.09, and 1.21 (95% confidence interval, 1.03-1.43) for dietary glycemic index and 1.00, 1.06, 0.97, 1.23, and 1.34 (95% confidence interval, 1.13-1.58) for dietary glycemic load. CONCLUSION: High intake of foods with a high glycemic index and glycemic load, especially rice, the main carbohydrate-contributing food in this population, may increase the risk of type 2 diabetes mellitus in Chinese women.     

Processed meat intake and incidence of Type 2 diabetes in younger and middle-aged women

Aim/hypothesis The aim of this study was to investigate the association between processed and other meat intake and incidence of Type 2 diabetes in a large cohort of women.Methods Incident cases of Type 2 diabetes were identified during 8 years of follow-up in a prospective cohort study of 91246 U.S. women aged 26 to 46 years and being free of diabetes and other major chronic diseases at baseline in 1991.Results We identified 741 incident cases of confirmed Type 2 diabetes during 716276 person-years of follow-up. The relative risk adjusted for potential non-dietary confounders was 1.91 (95% CI: 1.42–2.57) in women consuming processed meat five times or more a week compared with those consuming processed meat less than once a week (p<0.001 for trend). Further adjustment for intakes of magnesium, cereal fibre, glycaemic index, and caffeine or for a Western dietary pattern did not appreciably change the results and associations remained strong after further adjustment for fatty acid and cholesterol intake. Frequent consumption of bacon, hot dogs, and sausage was each associated with an increased risk of diabetes. While total red meat (beef or lamb as main dish, pork as main dish, hamburger, beef, pork or lamb as sandwich or mixed dish) intake was associated with an increased risk of diabetes, this association was attenuated after adjustment for magnesium, cereal fiber, glycaemic index, and caffeine (relative risk: 1.44; 95% CI: 0.92–2.24).Conclusion/interpretation Our data suggest that diets high in processed meats could increase the risk for developing Type 2 diabetes.Abbreviations RR relative risk     

BMI trajectory and subsequent risk of type 2 diabetes among middle-aged women

Background and aimsLittle is known about how weight trajectories among women during menopausal transition and beyond may be related to risk of type 2 diabetes mellitus (T2DM). The aim of this study was to examine associations between body mass index (BMI) trajectories over 20 years, age of obesity onset, cumulative obese-years and incidence of T2DM among middle-aged women.Methods and results12,302 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed in 1996 (Survey 1, age 45–50), 1998 and then every three years to 2016. Self-reported weight and height were collected for up to eight time points. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes. Growth mixture models were used to identify distinct BMI trajectories. A total of 1380 (11.2%) women newly developed T2DM over an average 16 years of follow-up. Seven distinct BMI trajectories were identified with differential risk of developing T2DM. Initial BMI was positively associated with T2DM risk. We also observed that risk of T2DM was positively associated with rapid weight increase, early age of obesity onset and greater obese-years.ConclusionSlowing down weight increases, delaying the onset of obesity, or reducing cumulative exposure to obesity may substantially lower the risk of developing T2DM.     

Prevalence and risk factors of type 2 diabetes in middle-aged women in Northern Vietnam

The existing gender difference in prevalence of type 2 diabetes may be explained partly by women’s reproductive patterns. A cross-sectional study was designed to investigate the prevalence of type 2 diabetes, prediabetes, and their association with reproductive patterns, socio-economic status, and anthropometric measures in Vietnamese women. Potential risk factors for the conditions were analyzed using multivariate logistic regression in the adjusted model, taken into account the influences of the reproductive patterns (age at menarche and menopause, year since menopause, number of children, and newborn weight), obesity-related measures, socio-economic status, and lifestyle-related factors. The age-adjusted prevalences of prediabetes and type 2 diabetes were 10.1 and 4.7 %, respectively. The prevalence of diabetes increased with age and reached a peak in the 60–64 group. Systolic blood pressure, waist–hip ratio, and family history of diabetes were the most significant risk factors for type 2 diabetes. The adjusted analysis model indicated that women with early menopause (45 years of age) were 3.4-fold and 2.7-fold more likely to suffer from type 2 diabetes and prediabetes, respectively, in comparison to women with normal age at menopause. More attention should be given to elderly women with early menopause, elevated systolic blood pressure, and increased obesity-related measures, who are at high risk of prediabetes and type 2 diabetes.     

Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct

Aims/hypothesis

Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults.

Methods

We established a case–cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case–cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence.

Results

In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence.

Conclusions/interpretation

This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.