Lodefalk M, Aman J, Bang P
Paediatric Endocrinology and Diabetes Unit, Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
Diabet Med. 2008 Sep;25(9):1030-5. doi: 10.1111/j.1464-5491.2008.02530.x.
To compare the glycaemic response to meals with different fat content in adolescents with Type 1 diabetes mellitus (T1DM) and to investigate associations with gastric emptying.
In this randomized, cross-over study, paired results were obtained from seven adolescents with T1DM who ingested on different days two meals with the same carbohydrate and protein content, but different fat and energy content (2 and 38 g fat, 320 and 640 kcal, respectively). Paracetamol was mixed into the meals and gastric emptying was estimated by the paracetamol absorption method. All subjects were normoglycaemic and given 7 IU insulin aspart at commencement of ingestion. Postprandial blood samples were taken during 4 h.
The areas under the curves for plasma glucose and serum paracetamol concentrations were larger after the low-fat than after the high-fat meal during the first 2 h (P = 0.047 and P = 0.041, respectively). The difference between meals in time-to-peak in glucose and paracetamol concentrations did not reach statistical significance (high-fat vs. low-fat meal: 210 min (120-240) vs. 120 min (50-240), P = 0.080 and 120 min (75-180) vs. 60 min (60-120), P = 0.051, respectively). Changes in glucose concentrations correlated with simultaneous changes in paracetamol concentrations (P < 0.001).
For the first time, we have shown that the initial glycaemic response is reduced after a meal with higher compared with a meal with lower fat content in adolescents with T1DM given a rapid-acting insulin analogue preprandially. The type and dose of preprandial insulin may need adjustment to the fat content of the meal to reach postprandial normoglycaemia.
比较1型糖尿病（T1DM）青少年对不同脂肪含量餐食的血糖反应，并研究其与胃排空的相关性。
在这项随机交叉研究中，从7名T1DM青少年中获得配对结果，他们在不同日期摄入了两份碳水化合物和蛋白质含量相同，但脂肪和能量含量不同（分别为2克和38克脂肪，320千卡和640千卡）的餐食。将对乙酰氨基酚混入餐食中，并通过对乙酰氨基酚吸收法估算胃排空情况。所有受试者血糖正常，在摄入餐食开始时给予7 IU门冬胰岛素。在4小时内采集餐后血样。
在最初2小时内，低脂餐食后血浆葡萄糖和血清对乙酰氨基酚浓度的曲线下面积高于高脂餐食后（分别为P = 0.047和P = 0.041）。葡萄糖和对乙酰氨基酚浓度达到峰值的时间在餐食之间的差异未达到统计学意义（高脂餐与低脂餐：210分钟（120 - 240）对120分钟（50 - 240），P = 0.080；120分钟（75 - 180）对60分钟（60 - 120），P = 0.051）。葡萄糖浓度的变化与对乙酰氨基酚浓度的同时变化相关（P < 0.001）。
我们首次表明，在餐前给予速效胰岛素类似物的T1DM青少年中，与低脂餐食相比，高脂餐食后初始血糖反应降低。餐前胰岛素的类型和剂量可能需要根据餐食的脂肪含量进行调整，以实现餐后血糖正常。
