Charles Perkins Centre and the School of Molecular Bioscience, The University of Sydney, Sydney, Australia Joslin Diabetes Center, Boston, MA.
Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle, Rankin Park, Australia.
Diabetes Care. 2015 Jun;38(6):1008-15. doi: 10.2337/dc15-0100.
Continuous glucose monitoring highlights the complexity of postprandial glucose patterns present in type 1 diabetes and points to the limitations of current approaches to mealtime insulin dosing based primarily on carbohydrate counting.
A systematic review of all relevant biomedical databases, including MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, was conducted to identify research on the effects of dietary fat, protein, and glycemic index (GI) on acute postprandial glucose control in type 1 diabetes and prandial insulin dosing strategies for these dietary factors.
All studies examining the effect of fat (n = 7), protein (n = 7), and GI (n = 7) indicated that these dietary factors modify postprandial glycemia. Late postprandial hyperglycemia was the predominant effect of dietary fat; however, in some studies, glucose concentrations were reduced in the first 2-3 h, possibly due to delayed gastric emptying. Ten studies examining insulin bolus dose and delivery patterns required for high-fat and/or high-protein meals were identified. Because of methodological differences and limitations in experimental design, study findings were inconsistent regarding optimal bolus delivery pattern; however, the studies indicated that high-fat/protein meals require more insulin than lower-fat/protein meals with identical carbohydrate content.
These studies have important implications for clinical practice and patient education and point to the need for research focused on the development of new insulin dosing algorithms based on meal composition rather than on carbohydrate content alone.
连续血糖监测突出了 1 型糖尿病餐后血糖模式的复杂性，并指出了目前基于碳水化合物计数的餐时胰岛素剂量调整方法的局限性。
对所有相关的生物医学数据库（包括 MEDLINE、Embase、CINAHL 和 Cochrane 对照试验中心注册库）进行了系统回顾，以确定关于膳食脂肪、蛋白质和血糖生成指数（GI）对 1 型糖尿病急性餐后血糖控制以及这些膳食因素的餐时胰岛素给药策略的研究。
所有研究检查脂肪（n = 7）、蛋白质（n = 7）和 GI（n = 7）的效果均表明这些膳食因素可改变餐后血糖。餐后晚期高血糖是脂肪的主要影响；然而，在一些研究中，葡萄糖浓度在前 2-3 小时降低，可能是由于胃排空延迟。确定了 10 项研究，这些研究检查了高脂肪和/或高蛋白膳食所需的胰岛素推注剂量和输送模式。由于方法学差异和实验设计的局限性，关于最佳推注输送模式的研究结果不一致；然而，这些研究表明，高脂肪/蛋白质餐需要比相同碳水化合物含量的低脂肪/蛋白质餐更多的胰岛素。
这些研究对临床实践和患者教育具有重要意义，并指出需要研究基于膳食成分而不是仅基于碳水化合物含量的新胰岛素剂量调整算法。
