Pearce Karma L, Noakes Manny, Keogh Jennifer, Clifton Peter M
Commonwealth Scientific and Industrial Research Organization, and Department of Physiology, University of Adelaide, Adelaide, South Australia, Australia.
Am J Clin Nutr. 2008 Mar;87(3):638-44. doi: 10.1093/ajcn/87.3.638.
Large postprandial glucose peaks are associated with increased risk of diabetic complications and cardiovascular disease.
We investigated the effect of carbohydrate distribution on postprandial glucose peaks with continuous blood glucose monitoring (CGMS), when consuming a moderate carbohydrate diet in energy balance in subjects with type 2 diabetes.
Twenty-three subjects with type 2 diabetes were randomly assigned to each of four 3-d interventions in a crossover design with a 4-d washout period. Identical foods were provided for each treatment with a ratio of total carbohydrate to protein to fat of 40%:34%:26% but differing in carbohydrate content at each meal: even distribution (CARB-E; approximately 70 g carbohydrate), breakfast (CARB-B), lunch (CARB-L), and dinner(CARB-D), each providing approximately 125 g carbohydrate in the loaded meal in a 9-MJ diet. Glucose concentrations were continuously measured with CGMS. Outcomes were assessed by postprandial peak glucose (G(max)), time spent > 12 mmol/L (T > 12), and total area under the glucose curve (AUC(20)).
Daily G(max) differed between treatments (P = 0.003) with CARB-L (14.2 +/- 1.0 mmol/L), CARB-E (14.5 +/- 0.9 mmol/L), and CARB-D (14.6 +/- 0.8 mmol/L) being similar but lower than CARB-B (16.5 +/- 0.8 mmol/L). Meal G(max) was weakly related to carbohydrate amount and glycemic load (r = 0.40-0.44). T > 12 differed between treatments (P = 0.014), and a treatment x fasting blood glucose (FBG) interaction (P = 0.003) was observed with CARB-L (184 +/- 74 min) < CARB-B (190 +/- 49 min) < CARB-D (234 +/- 87 min) < CARB-E (262 +/- 91 min). Total AUC(20) was not significantly different between treatments. After adjustment for FBG, treatment became significant (P = 0.006); CARB-L (10 049 +/- 718 mmol/L x 20 h) < CARB-E (10 493 +/- 706 mmol/L x 20 h) < CARB-B (10 603 +/- 642 mmol/L x 20 h) < CARB-D (10 717 +/- 638 mmol/L x 20 h).
CARB-E did not optimize blood glucose control as assessed by postprandial peaks, whereas CARB-L provided the most favorable postprandial profile.
餐后血糖大幅升高与糖尿病并发症及心血管疾病风险增加相关。
在2型糖尿病患者能量平衡状态下摄入适度碳水化合物饮食时，我们采用动态血糖监测（CGMS）研究碳水化合物分布对餐后血糖峰值的影响。
23例2型糖尿病患者采用交叉设计，随机分配至4种为期3天的干预措施，每种干预措施之间有4天的洗脱期。每种治疗提供相同的食物，总碳水化合物与蛋白质与脂肪的比例为40%：34%：26%，但每餐碳水化合物含量不同：均匀分布（CARB-E；约70克碳水化合物）、早餐（CARB-B）、午餐（CARB-L）和晚餐（CARB-D），在9兆焦耳饮食的负荷餐中，每餐提供约125克碳水化合物。用CGMS连续测量血糖浓度。通过餐后血糖峰值（G(max)）、血糖>12 mmol/L的时间（T>12）和血糖曲线下总面积（AUC(20)）评估结果。
各治疗组的每日G(max)不同（P = 0.003），CARB-L（14.2±1.0 mmol/L）、CARB-E（14.5±0.9 mmol/L）和CARB-D（14.6±0.8 mmol/L）相似，但低于CARB-B（16.5±0.8 mmol/L）。餐时G(max)与碳水化合物量和血糖负荷呈弱相关（r = 0.40 - 0.44）。各治疗组的T>12不同（P = 0.014），观察到治疗与空腹血糖（FBG）的交互作用（P = 0.003），CARB-L（184±74分钟）<CARB-B（190±49分钟）<CARB-D（234±87分钟）<CARB-E（262±91分钟）。各治疗组的总AUC(20)无显著差异。校正FBG后，治疗组差异有统计学意义（P = 0.006）；CARB-L（10 049±718 mmol/L×20小时）<CARB-E（10 493±706 mmol/L×20小时）<CARB-B（10 603±642 mmol/L×20小时）<CARB-D（10 717±638 mmol/L×20小时）。
通过餐后峰值评估，CARB-E未优化血糖控制，而CARB-L提供了最有利的餐后血糖曲线。
