Ryan Rochelle L, King Bruce R, Anderson Donald G, Attia John R, Collins Clare E, Smart Carmel E
School of Medicine, Faculty of Health, University of Newcastle, Newcastle, Australia.
Diabetes Care. 2008 Aug;31(8):1485-90. doi: 10.2337/dc08-0331. Epub 2008 May 5.
The purpose of this study was to quantify the effects of glycemic index on postprandial glucose excursion (PPGE) in children with type 1 diabetes receiving multiple daily injections and to determine optimal insulin therapy for a low-glycemic index meal.
Twenty subjects consumed test breakfasts with equal macronutrient contents on 4 consecutive days; high-and low-glycemic index meals (glycemic index 84 vs. 48) were consumed with preprandial ultra-short-acting insulin, and the low-glycemic index meal was also consumed with preprandial regular insulin and postprandial ultra-short-acting insulin. Each child's insulin dose was standardized. Continuous glucose monitoring was used.
The PPGE was significantly lower for the low-glycemic index meal compared with the high-glycemic index meal at 30-180 min (P < 0.02) when preprandial ultra-short-acting insulin was administered. The maximum difference occurred at 60 min (4.2 mmol/l, P < 0.0001). Regular insulin produced a 1.1 mmol/l higher PPGE at 30 min compared with ultra-short-acting insulin (P = 0.015) when the low-glycemic index meal was consumed. Postprandial ultra-short-acting insulin produced a higher PPGE at 30 and 60 min compared with preprandial administration when the low-glycemic index meal was consumed. The maximum difference was 2.5 mmol/l at 60 min (P < 0.0001).
Low-glycemic index meals produce a lower PPGE than high-glycemic index meals. Preprandial ultra-short-acting insulin is the optimal therapy for a low-glycemic index meal.
本研究旨在量化血糖指数对接受每日多次注射胰岛素治疗的1型糖尿病儿童餐后血糖波动（PPGE）的影响，并确定针对低血糖指数餐的最佳胰岛素治疗方案。
20名受试者连续4天食用宏量营养素含量相同的试验早餐；在餐前注射超短效胰岛素的情况下，分别食用高血糖指数餐和低血糖指数餐（血糖指数分别为84和48），并且在食用低血糖指数餐时，还在餐前注射常规胰岛素以及在餐后注射超短效胰岛素。每个儿童的胰岛素剂量均标准化。采用持续葡萄糖监测。
在餐前注射超短效胰岛素的情况下，与高血糖指数餐相比，低血糖指数餐在30 - 180分钟时的PPGE显著更低（P < 0.02）。最大差异出现在60分钟时（4.2 mmol/L，P < 0.0001）。在食用低血糖指数餐时，与超短效胰岛素相比，常规胰岛素在30分钟时使PPGE升高1.1 mmol/L（P = 0.015）。在食用低血糖指数餐时，与餐前注射相比餐后注射超短效胰岛素在30和60分钟时产生更高的PPGE。最大差异在60分钟时为2.5 mmol/L（P < 0.0001）。
低血糖指数餐比高血糖指数餐产生更低的PPGE。餐前注射超短效胰岛素是针对低血糖指数餐的最佳治疗方法。
