The Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, New South Wales 2145, Australia.
J Clin Endocrinol Metab. 2013 May;98(5):2116-25. doi: 10.1210/jc.2012-4251. Epub 2013 Mar 26.
Prediabetes and clinical insulin resistance in adolescents are rapidly emerging clinical problems with serious health outcomes.
The objective of this study was to determine the efficacy of 2 structured lifestyle interventions, both differing in diet macronutrient composition, on insulin sensitivity.
This study was a randomized controlled trial, known as Researching Effective Strategies to Improve Insulin Sensitivity in Children and Teenagers, in 2 hospitals in Sydney, Australia.
Participants included overweight or obese 10- to 17-year-olds with either prediabetes and/or clinical features of insulin resistance.
At baseline adolescents were prescribed metformin and randomized to a structured diet, which was either high carbohydrate or moderate carbohydrate with increased protein. The program commenced with a 3-month dietary intervention, with the addition of an exercise intervention in the next 3 months.
The outcomes included an insulin sensitivity, anthropometry, and cardiometabolic profile at 6 months.
One hundred eleven subjects (66 girls) were recruited and 98 subjects (58 girls) completed the 6-month intervention. After 3 months the mean insulin sensitivity index increased by 0.3 [95% confidence interval (CI) 0.2-0.4]. After 6 months the mean insulin (picomoles per liter) to glucose ratio (millimoles per liter) decreased by 7.2 [95%CI -12.0 to -2.3], body mass index, expressed as a percentage of the 95th centile, decreased by 9% (95% CI -3 to -15), but there was no significant change in the lipids. There were no significant differences in outcomes between the diet groups at any time point.
These results are in contrast with our hypothesis that adolescents randomized to the increased protein diet would have better outcomes. Further strategies are required to better address prediabetes and clinical features of insulin resistance in adolescents.
青少年的糖尿病前期和临床胰岛素抵抗是迅速出现的临床问题，会带来严重的健康后果。
本研究旨在确定两种不同的结构化生活方式干预措施在胰岛素敏感性方面的疗效，这两种干预措施的饮食宏量营养素组成不同。
这是一项在澳大利亚悉尼的 2 家医院进行的随机对照试验，称为“研究改善儿童和青少年胰岛素敏感性的有效策略”。
参与者包括超重或肥胖的 10 至 17 岁青少年，他们有糖尿病前期和/或胰岛素抵抗的临床特征。
在基线时，青少年被开了二甲双胍，并随机分配到一种结构化饮食，这种饮食要么是高碳水化合物，要么是中等碳水化合物加高蛋白。该方案首先进行 3 个月的饮食干预，然后在接下来的 3 个月中加入运动干预。
在 6 个月时评估了胰岛素敏感性、人体测量学和心血管代谢特征。
共招募了 111 名受试者（66 名女孩），其中 98 名受试者（58 名女孩）完成了 6 个月的干预。3 个月后，胰岛素敏感指数平均增加 0.3[95%置信区间（CI）0.2-0.4]。6 个月后，胰岛素（皮摩尔/升）与血糖（毫摩尔/升）比值平均降低 7.2[95%CI -12.0 至 -2.3]，体重指数以第 95 百分位数的百分比表示，降低了 9%（95%CI -3 至 -15），但血脂无显著变化。在任何时间点，两组饮食的结果均无显著差异。
这些结果与我们的假设相反，即随机分配到高蛋白饮食组的青少年会有更好的结果。需要进一步的策略来更好地解决青少年的糖尿病前期和临床胰岛素抵抗问题。
