Department of Nutritional Sciences, University of Toronto, and Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Nutr Metab Cardiovasc Dis. 2011 Sep;21(9):719-25. doi: 10.1016/j.numecd.2010.12.005. Epub 2011 Feb 16.
We aimed to determine the effects on glycemic responses and potential risk of hypoglycaemia in type 1 diabetic subjects of replacing half the starch in a meal with sugars, and of adding fat to the low-sugar and high-sugar meals.
We studied overnight fasted subjects with type 1 diabetes (n = 11) and age-, BMI- and ethnicity-matched controls (n = 11) using a 2 × 2 factorial design. The low-sugar/low-fat meal was 110 g white-bread. In the high-sugar/low-fat meal half the white-bread starch replaced by sugars (jam and orange juice). The high-fat meals consisted of the low-fat meals plus 20 g fat (margarine). The significance of the main effects of sugars and fat and the sugar × fat, group × sugar and group × fat interactions were determined by ANOVA. In control and diabetic subjects, respectively, high-sugar significantly reduced time to peak rise by 13% (P = 0.004) and 32% (P = 0.004; group × sugar: P = 0.01) and increased peak rise by 14% and 10% (ns). Adding fat increased time to peak rise by 17-19% in both groups (P = 0.003), reduced peak rise by 31% in normal (P < 0.001) but increased peak rise in diabetic subjects by 3% (ns) (group × fat: P = 0.022). Blood glucose nadir and occurrence of hypoglycaemia were similar among the 4 meals.
In type 1 diabetes, insulin adjustment to avoid hypoglycemia may be useful for meals in which the proportion of carbohydrate absorbed as glucose is <0.75, however the precise level which increases hypoglycaemic risk requires further research. The results suggest that people with type 1 diabetes should not be advised to add fat to meals to reduce glycemic responses.
我们旨在确定在 1 型糖尿病患者中，用糖替代餐中一半的淀粉，以及在低糖和高糖餐中添加脂肪，对血糖反应和低血糖风险的影响。
我们采用 2×2 析因设计，研究了 11 例 1 型糖尿病患者（n=11）和年龄、BMI 和种族匹配的对照组（n=11）的 overnight fasted subjects。低糖/低脂肪餐为 110g 白面包。在高糖/低脂肪餐中，一半的白面包淀粉被糖（果酱和橙汁）替代。高脂肪餐由低脂肪餐加 20g 脂肪（人造黄油）组成。通过 ANOVA 确定糖和脂肪的主要效应以及糖×脂肪、组×糖和组×脂肪相互作用的显著性。在对照组和糖尿病组中，高糖分别显著减少 13%（P=0.004）和 32%（P=0.004；组×糖：P=0.01）的达峰时间，并分别增加 14%和 10%的峰值（无统计学意义）。添加脂肪使两组的达峰时间分别增加 17-19%（P=0.003），使正常组的峰值降低 31%（P<0.001），但使糖尿病组的峰值升高 3%（无统计学意义）（组×脂肪：P=0.022）。4 种餐食的血糖最低点和低血糖发生情况相似。
在 1 型糖尿病中，为避免低血糖而调整胰岛素可能对吸收的碳水化合物中有<0.75 部分以葡萄糖形式吸收的餐食有用，但是增加低血糖风险的确切水平需要进一步研究。结果表明，不建议 1 型糖尿病患者添加脂肪来降低血糖反应。
