Kempf K, Schloot N C, Gärtner B, Keil R, Schadewaldt P, Martin S
West-German Centre of Diabetes and Health, Düsseldorf Catholic Hospital Group, Düsseldorf, Germany.
J Hum Nutr Diet. 2014 Apr;27 Suppl 2:21-7. doi: 10.1111/jhn.12145. Epub 2013 Aug 2.
Despite high insulin doses, good glycaemic control is often lacking in type 2 diabetes patients and new therapeutic options are needed.
In a proof of principle study, an energy-restricted, protein-rich meal replacement (PRMR) was examined as a means of reducing insulin requirement, HbA1C and body weight. Obese type 2 diabetes patients (n = 22) with >100 U insulin per day replaced, in week 1, the three main meals with 50 g of PRMR (Almased-Vitalkost) each (= 4903 kJ day(-1) ). In weeks 2-4, breakfast and dinner were replaced, and, in weeks 5-12, only dinner was replaced. Clinical parameters were determined at baseline, and after 4, 8 and 12 weeks, as well as after 1.5 years of follow-up. The Wilcoxon signed-rank test was used for the intention-to-treat analysis and the Mann-Whitney U-test for subgroup analyses.
The 12-week-programme was completed by 15 participants (68%). After 1 week, the mean insulin dose was reduced from 147 (75) U to 91 (55) U day(-1) (P = 0.0001), and to 65 (32) U (P < 0.0001) after 12 weeks of study. Over a period of 12 weeks, HbA1c decreased from 8.8% (1.4%) to 8.1% (1.6%) (P = 0.048) and weight decreased from 118.0 (19.7) kg to 107.4 (19.2) kg (P < 0.0001). Moreover, body mass index, waist and hip circumference, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol improved significantly. After 1.5 years, insulin requirement and weight remained significantly lower than baseline. Participants who continued PRMR further reduced their HbA1c, weight and insulin dose. Two patients were able to stop insulin therapy altogether.
Energy-restricted PRMR was effective in reducing insulin requirement of type 2 diabetes patients with intensified insulin therapy accompanied by a reduction of HbA1c, weight and other cardiometabolic risk factors. With the continuous use of PRMR, glycaemic control might be improved in the long term.
尽管2型糖尿病患者使用了高剂量胰岛素，但血糖控制往往仍不理想，因此需要新的治疗方案。
在一项原理验证研究中，研究了一种能量受限、富含蛋白质的代餐（PRMR）作为降低胰岛素需求量、糖化血红蛋白（HbA1C）和体重的一种方法。每日胰岛素用量超过100 U的肥胖2型糖尿病患者（n = 22）在第1周用每餐50 g的PRMR（Almased-Vitalkost）替代三餐（= 4903 kJ·天-1）。在第2至4周，替代早餐和晚餐，在第5至12周，仅替代晚餐。在基线时、4周、8周和12周后以及随访1.5年后测定临床参数。采用Wilcoxon符号秩检验进行意向性分析，采用Mann-Whitney U检验进行亚组分析。
15名参与者（68%）完成了为期12周的方案。1周后，平均胰岛素用量从147（75）U降至91（55）U·天-1（P = 0.0001），研究12周后降至65（32）U（P < 0.0001）。在12周的时间里，糖化血红蛋白从8.8%（1.4%）降至8.1%（1.6%）（P = 0.048），体重从118.0（19.7）kg降至107.4（19.2）kg（P < 0.0001）。此外，体重指数、腰围和臀围、空腹血糖、甘油三酯和高密度脂蛋白胆固醇均有显著改善。1.5年后，胰岛素需求量和体重仍显著低于基线水平。继续使用PRMR的参与者进一步降低了糖化血红蛋白、体重和胰岛素用量。两名患者能够完全停止胰岛素治疗。
能量受限的PRMR可有效降低强化胰岛素治疗的2型糖尿病患者的胰岛素需求量，同时降低糖化血红蛋白、体重和其他心血管代谢危险因素。持续使用PRMR可能长期改善血糖控制。
