Scheuing Nicole, Thon Angelika, Konrad Katja, Bauer Maria, Karsten Claudia, Meissner Thomas, Seufert Jochen, Schönau Eckhard, Schöfl Christof, Woelfle Joachim, Holl Reinhard W
Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, 89081 Ulm, Germany.
Hannover Medical School, Department of Pediatrics, 30625 Hannover, Germany.
Clin Nutr. 2015 Aug;34(4):732-8. doi: 10.1016/j.clnu.2014.08.016. Epub 2014 Sep 15.
BACKGROUND & AIMS: In cystic fibrosis-related diabetes (CFRD), energy needs differ from type 1 (T1D) or type 2 diabetes, and endogenous insulin secretion is not totally absent. We analyzed whether daily carbohydrate intake, its diurnal distribution and insulin requirement per 11 g of carbohydrate differ between CFRD and T1D.
Anonymized data of 223 CFRD and 36,780 T1D patients aged from 10 to <30 years from the multicenter diabetes registry DPV were studied. Carbohydrate intake and insulin requirement were analyzed using multivariable regression modeling with adjustment for age and sex. Moreover, carbohydrate intake was compared to the respective recommendations (CFRD: energy intake 130% of general population with 45% carbohydrates; T1D: carbohydrate intake 50% of total energy).
After demographic adjustment, carbohydrate intake (238 ± 4 vs. 191 ± 1 g/d, p < 0.001) and meal-related insulin (0.52 ± 0.02 vs. 0.47 ± 0.004 IU/kgd, p = 0.001) were higher in CFRD, whereas basal insulin (0.27 ± 0.01 vs. 0.38 ± 0.004 IU/kgd, p < 0.001) and total insulin requirement per 11 g of carbohydrate (1.15 ± 0.06 vs. 1.70 ± 0.01 IU/d, p < 0.001) were lower compared to T1D. CFRD patients achieved 62% [Q1;Q3: 47; 77] of recommended carbohydrate intake and T1D patients 60% [51; 71] of age- and gender-specific recommended intake (p < 0.001). CFRD and T1D patients had a carbohydrate intake below healthy peers (79% [58; 100] and 62% [52; 74], p < 0.001). The circadian rhythm of insulin sensitivity persisted in CFRD and the diurnal distribution of carbohydrates was comparable between groups.
In pediatric and young adult patients, carbohydrate intake and insulin requirement differ clearly between CFRD and T1D. However, both CFRD and T1D patients seem to restrict carbohydrates.
在囊性纤维化相关糖尿病(CFRD)中,能量需求不同于1型糖尿病(T1D)或2型糖尿病,且内源性胰岛素分泌并非完全缺失。我们分析了CFRD与T1D患者之间每日碳水化合物摄入量、其昼夜分布以及每11克碳水化合物的胰岛素需求量是否存在差异。
研究了来自多中心糖尿病登记系统DPV的223例年龄在10至30岁以下的CFRD患者和36780例T1D患者的匿名数据。使用多变量回归模型分析碳水化合物摄入量和胰岛素需求量,并对年龄和性别进行调整。此外,将碳水化合物摄入量与各自的推荐量进行比较(CFRD:能量摄入量为一般人群的130%,其中45%为碳水化合物;T1D:碳水化合物摄入量占总能量的50%)。
经过人口统计学调整后,CFRD患者的碳水化合物摄入量(238±4 vs. 191±1克/天,p<0.001)和与进餐相关的胰岛素量(0.52±0.02 vs. 0.47±0.004国际单位/千克·天,p = 0.001)较高,而基础胰岛素量(0.27±0.01 vs. 0.38±0.004国际单位/千克·天,p<0.001)和每11克碳水化合物的总胰岛素需求量(1.15±0.06 vs. 1.70±0.01国际单位/天,p<0.001)低于T1D患者。CFRD患者达到推荐碳水化合物摄入量的62%[第一四分位数;第三四分位数:47;77],T1D患者达到年龄和性别特异性推荐摄入量的60%[51;71](p<0.001)。CFRD和T1D患者的碳水化合物摄入量低于健康同龄人(分别为79%[58;100]和62%[52;74],p<0.001)。CFRD患者胰岛素敏感性的昼夜节律持续存在,两组之间碳水化合物的昼夜分布具有可比性。
在儿童和年轻成人患者中,CFRD与T1D患者的碳水化合物摄入量和胰岛素需求量存在明显差异。然而,CFRD和T1D患者似乎都限制了碳水化合物的摄入。