Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia.
Diabet Med. 2010 Feb;27(2):238-41. doi: 10.1111/j.1464-5491.2009.02900.x.
Current guidelines for dietary management of Type 1 diabetes in children recommend a carbohydrate supper before bed. However, with the introduction of insulin analogues such as glargine (with a basal insulin profile), supper may be unnecessary. The purpose of this study was to investigate whether supper is required to prevent nocturnal hypoglycaemia when using multiple daily injections, with glargine as the basal insulin and rapid-acting insulin pre-meals, in older children with Type 1 diabetes.
Thirty-five children aged 10-18 years with Type 1 diabetes were recruited to a randomized cross-over trial (supper vs. no supper). Each phase consisted of three consecutive days of wearing a continuous glucose-monitoring system (CGMS) to record nocturnal blood glucose levels in the home setting. The supper phase included one 15-g carbohydrate dairy snack consumed before bed. The evening meals were standardized. Activity was restricted.
Valid CGMS data were obtained for 163 nights (85 supper, 78 no supper). Nocturnal hypoglycaemia rates were similar in the supper and no-supper groups (32.9% vs. 33.3% of nights; P = 0.96).
This study suggests that supper is not necessary for all children to prevent nocturnal hypoglycaemia when using glargine insulin. The recommendation for inclusion of supper should be individually tailored and not mandatory.
目前，针对儿童 1 型糖尿病的饮食管理指南建议在睡前吃一顿碳水化合物晚餐。然而，随着甘精胰岛素（具有基础胰岛素特征）等胰岛素类似物的引入，晚餐可能变得不必要。本研究旨在探讨在使用多次注射方案（甘精胰岛素作为基础胰岛素，速效胰岛素作为餐前胰岛素）治疗时，对于年龄较大的 1 型糖尿病儿童，是否需要晚餐来预防夜间低血糖。
35 名年龄在 10-18 岁的 1 型糖尿病儿童被招募参与一项随机交叉试验（晚餐组与无晚餐组）。每个阶段包括连续三天佩戴连续血糖监测系统（CGMS），以记录家庭环境中的夜间血糖水平。晚餐组在睡前吃一份含有 15 克碳水化合物的乳制品零食。晚餐标准化，限制活动。
获得了 163 个夜间（85 个晚餐，78 个无晚餐）有效的 CGMS 数据。晚餐组和无晚餐组的夜间低血糖发生率相似（32.9%vs. 33.3%的夜间；P=0.96）。
本研究表明，对于使用甘精胰岛素的所有儿童，晚餐并非预防夜间低血糖的必要措施。应根据个体情况量身定制是否添加晚餐，而不是强制性的。
