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

王娴; 潘研; 巴明玉; 万红; 符宇; 燕树勋

doi:10.16766/j.cnki.issn.1674-4152.002681

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

doi: 10.16766/j.cnki.issn.1674-4152.002681

河南中医药大学第一附属医院内分泌科二病区，河南郑州 450001

基金项目:

2019年全国中医特色技术传承骨干人才培训项目 2100601-CZ01-01

河南省中医药科学研究专项课题 2022JDZX021

详细信息

通讯作者:
潘研, E-mail: lindapanyan@126.com

中图分类号: R587.1R459.3
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出版历程
- 收稿日期: 2021-01-12
- 网络出版日期: 2022-11-30

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

Department of Endocrinology, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan 450001, China

摘要

摘要: 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。
- 动态血糖监测 /
- 2型糖尿病 /
- 膳食平衡指数 /
- 平均血糖波动幅度
Abstract: 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.
- Continuous glucose monitoring /
- Diabetes mellitus type 2 /
- Dietary balance index-07 /
- Mean amplitude of glycemic excursions

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表 1 不同平均血糖波动幅度T2DM患者基本情况比较

Table 1. Comparison of basic situation of T2DM patients with different mean amplitude of blood glucose fluctuation

项目	低分位组	中分位组	高分位组	统计量	趋势性P值
基本情况
年龄(x±s，岁)	41.75±17.51	44.51±15.37	49.49±16.15	10.622^a	0.010
性别(例)				0.081^b	0.776
男性	44	94	60
女性	28	69	51
总胆固醇(x±s，mmol/L)	5.23±0.96	5.14±1.20	5.20±1.16	0.034^a	0.866
甘油三酯[M(P₂₅, P₇₅), mmol/L]	1.19(0.99, 1.88)	1.71(1.16, 2.47)	1.72(1.24, 2.62)	7.779^b	0.481
HDL-C(x±s，mmol/L)	1.17±0.16	1.13±0.19	1.08±0.21	3.165^a	0.079
LDL-C(x±s，mmol/L)	3.01±0.69	3.17±0.64	3.24±0.78	1.370^a	0.254
空腹血糖(x±s，mmol/L)	6.82±0.24	7.16±1.44	7.39±1.78	25.932^a	< 0.001
空腹胰岛素[M(P₂₅, P₇₅), mmol/L]	27.10(13.10，38.40)	23.80(14.37，34.70)	21.05(14.87，29.80)	2.267^b	0.084
糖化血红蛋白(x±s，%)	7.32±1.90	7.49±1.47	7.89±1.75	4.819^a	0.112
营养状况
血红蛋白(x±s，g/L)	134.53±23.18	130.62±29.33	133.74±21.75	1.940^a	0.166
总蛋白(x±s，g/L)	61.13±2.29	60.37±4.25	58.11±6.42	0.626^a	0.781
白蛋白(x±s，g/L)	41.81±2.42	42.93±6.89	38.23±5.44	4.374^a	0.063
前白蛋白(x±s，mg/L)	260.83±61.62	249.37±47.91	191.32±70.14	47.124^a	< 0.001
动态血糖参数
MBG(x±s，mmol/L)	9.73±1.91	9.88±1.95	10.63±2.11	11.990^a	0.047
SDBG[M(P₂₅, P₇₅), mmol/L]	2.09(1.20，2.50)	2.47(1.80，3.41)	4.19(2.08，4.94)	40.097^b	< 0.001
LAGE(x±s，mmol/L)	6.31±2.58	7.01±3.11	7.71±2.63	18.523^a	< 0.001
体成分参数
BMI(x±s)	24.73±1.71	26.48±1.14	23.72±1.12	8.538^a	< 0.001
脂肪量(x±s，kg)	18.32±7.95	18.29±6.38	17.56±6.62	19.331^a	0.251
四肢骨骼肌量(x±s，kg)	15.21±3.61	17.89±4.52	12.11±5.41	17.354^a	< 0.001
上臂肌围(x±s，cm)	30.88±3.21	29.03±2.45	28.91±2.58	31.526^a	0.439
药物使用情况(例)				2.458^b	0.117
口服药	35	27	31
胰岛素	21	48	46
口服药+胰岛素	16	88	34
注：^a为F值，^b为χ²值。

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表 2 不同平均血糖波动幅度T2DM患者各类食物摄入评分比较[M(P₂₅, P₇₅)，分]

Table 2. Comparison of food intake scores in T2DM patients with different mean glucose fluctuation amplitude[M(P₂₅, P₇₅), points]

组别	例数	粮谷类	蔬菜摄入量	水果摄入量	奶制品摄入量	豆类摄入量	肉类摄入量	蛋类摄入量	水产品摄入量	食用油摄入量
低分位组	72	0(0, 4)	-2(-2, 0)	-4(-2, 0)	-4(-2, -2)	-3(-3, 0)	-2(0, 0)	0(0, 2)	-4(-2, -2)	0(3, 3)
中分位组	163	-2(0, 4)	-4(-2, 0)	-4(-2, 0)	-4(-2, -2)	-3(0, 0)	-2(-2, 0)	-2(0, 0)	-4(-2, -2)	0(3, 6)
高分位组	111	-2(0, 4)	-4(-2, 0)^ab	-6(-4, -2)	-6(-4, -1)^ab	-6(-3, 0)	-2(0, 4)	-2(-2, 0)^a	-4(-2, -2)	3(6, 6)^a
χ²值		0.273	11.354	3.643	7.747	4.251	1.570	14.682	1.625	11.352
P值		0.872	0.003	0.162	0.021	0.119	0.456	0.001	0.444	0.003
注：与低分位组比较，^aP < 0.05;与中分位组比较，^bP < 0.05。

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表 3 各类食物摄入量与血糖波动幅度的多因素线性回归分析

Table 3. Multivariate linear regression analysis of food intake and blood glucose fluctuation

变量	B	SE	B’	t值	P值	OR值(95% CI)
Model 1
粮谷类得分＜4分	0.003	0.013	0.016	0.220	0.826	1.003(0.976~1.030)
蔬菜摄入量≥150 g/d	-0.139	0.034	-0.309	-4.044	＜0.001	0.870(0.813~0.931)
水果摄入量≥100 g/d	-0.001	0.027	-0.002	-0.030	0.975	0.999(0.947~1.053)
奶制品摄入量≥250 g/d	-0.172	0.038	-0.472	-4.538	＜0.001	0.842(0.791~0.895)
豆类摄入量≥30 g/d	-0.041	0.026	-0.137	-1.597	0.112	0.960(0.912~1.010)
肉类摄入量≥75 g/d	-0.029	0.025	-0.088	-1.164	0.246	0.980(0.971~1.080)
蛋类摄入量≥50 g/d	-0.097	0.030	-0.234	-3.169	0.002	0.908(0.856~0.965)
水产品摄入量≥50 g/d	0.042	0.044	0.077	0.954	0.342	1.043(0.956~1.138)
食用油摄入量≥30 g/d	0.056	0.027	0.187	2.069	0.040	1.058(1.003~1.115)
Model 2
蔬菜摄入量≥150 g/d	-0.104	0.033	-0.226	-3.189	0.003	0.901(0.845~0.962)
奶制品摄入量≥250 g/d	-0.151	0.041	-0.313	-4.214	0.002	0.860(0.818~0.895)
注：Model 1为未校正模型；Model 2调整的混杂因素为年龄、性别、空腹血糖；变量赋值如下，粮谷类得分＜4分=1，粮谷类得分≥4分=0；蔬菜摄入量≥150 g/d=1，蔬菜摄入量＜150 g/d=0；水果摄入量≥100 g/d=1，水果摄入量＜100 g/d=0；奶制品摄入量≥250 g/d=1，奶制品摄入量＜250 g/d=0；豆类摄入量≥30 g/d=1，豆类摄入量＜30 g/d=0；肉类摄入量≥75 g/d=1，肉类摄入量＜75 g/d=0；蛋类摄入量≥50 g/d=1，蛋类摄入量＜50 g/d=0；水产品摄入量≥50 g/d=1，水产品摄入量＜50 g/d=0；食用油摄入量≥30 g/d=1，食用油摄入量＜30 g/d=0。

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