2型糖尿病患者膳食因素与平均血糖波动幅度的关联性研究

  目的  应用动态血糖监测系统观察2型糖尿病(T2DM)患者的膳食状况与血糖波动情况之间的关联。  方法  选取2016年1月—2017年12月在河南中医药大学第一附属医院内分泌科住院的18~60岁2型糖尿病患者346例作为研究对象，行连续72 h动态血糖监测并分析其血糖波动情况。采用24 h膳食回顾法和3 d调味品估算法得到各类食物的平均每日摄入量，运用调整的膳食平衡指数(DBI-07)计算各类食物摄入分值。根据平均血糖波动幅度(MAGE)三分位数将研究对象分为3组，比较各组患者各类食物摄入分值差异并运用多因素线性回归模型分析膳食因素对2型糖尿病患者血糖波动情况的影响。  结果  随着平均血糖波动幅度增加，前白蛋白水平及四肢骨骼肌量降低，差异有统计学意义(F=47.124、17.354，趋势性P < 0.001、 < 0.001)；奶制品摄入量达到250 mL/d的T2DM人群其平均血糖波动幅度相较奶制品摄入不足患者下降14.0%(OR=0.860，95% CI:0.818~0.895)，而蔬菜摄入量达到150 g/d的T2DM人群平均血糖波动幅度较蔬菜摄入不足者下降9.9%(OR=0.901，95% CI:0.845~0.962)，将年龄、性别、HbA1c等因素纳入模型进行校正后关联依然存在。  结论  奶制品及蔬菜摄入不足和血糖波动性增加相关，在2型糖尿病的医学营养治疗中应重视预防蛋白质性营养不良和膳食纤维的摄入。 

Study on the relationship between dietary factors and mean amplitude of glycemic excursions in patients with diabetes mellitus type 2

  Objective  To observe the relationship between dietary factors and mean amplitude of glycemic excursions in diabetes mellitus type 2 (T2DM) patients with a dynamic blood glucose monitoring system.  Methods  A total of 346 patients with T2DM aged from 18 to 60 who were hospitalized in the Department of Endocrinology, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2016 to December 2017 were selected as the study subjects. They were monitored continuously for 72 hours and their amplitude of glycemic excursions were analyzed. The average daily intake of various foods was obtained by 24 hours dietary review method and 3 days condiment estimation method, and the adjusted dietary balance index-07 (DBI-07) was used to calculate the intake score of various foods. The subjects were divided into three groups according to the mean amplitude of glycemic excursions (MAGE) level, and the differences in food intake scores of each group were compared. Multivariate linear regression was used to assess the influence of dietary factors on amplitude of glycemic excursions.  Results  With the increase of the amplitude of glycemic excursions, the level of prealbumin and skeletal muscle mass of the limbs decreased (F=47.124, 17.354, trend P < 0.001, < 0.001). Participants consumed 250 mL of dairy products per day had a 14.0% decrease in the mean amplitude of glycemic excursions compared to those who did not consume enough dairy products (OR=0.860, 95% CI: 0.818-0.895). Participants with vegetable intake greater than 150 g/d had a 9.9% decrease in the mean amplitude of glycemic excursions compared with less vegetable intake (OR=0.901, 95% CI: 0.845-0.962).  Conclusion  Insufficient intake of dairy products and vegetable is associated with increased blood glucose fluctuation, and the prevention of protein malnutrition should be emphasized in the medical nutritional treatment in type 2 diabetes.