Campbell Matthew D, Walker Mark, Ajjan Ramzi A, Birch Karen M, Gonzalez Javier T, West Daniel J
1 Institute for Sport, Physical Activity & Leisure, Leeds Beckett University, Leeds, UK.
2 Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
Diab Vasc Dis Res. 2017 Jul;14(4):336-344. doi: 10.1177/1479164117698918. Epub 2017 Mar 21.
To evaluate an additional rapid-acting insulin bolus on postprandial lipaemia, inflammation and pro-coagulation following high-carbohydrate high-fat feeding in people with type 1 diabetes.
A total of 10 males with type 1 diabetes [HbA 52.5 ± 5.9 mmol/mol (7.0% ± 0.5%)] underwent three conditions: (1) a low-fat (LF) meal with normal bolus insulin, (2), a high-fat (HF) meal with normal bolus insulin and (3) a high-fat meal with normal bolus insulin with an additional 30% insulin bolus administered 3-h post-meal (HFA). Meals had identical carbohydrate and protein content and bolus insulin dose determined by carbohydrate-counting. Blood was sampled periodically for 6-h post-meal and analysed for triglyceride, non-esterified-fatty acids, apolipoprotein B48, glucagon, tumour necrosis factor alpha, fibrinogen, human tissue factor activity and plasminogen activator inhibitor-1. Continuous glucose monitoring captured interstitial glucose responses.
Triglyceride concentrations following LF remained similar to baseline, whereas triglyceride levels following HF were significantly greater throughout the 6-h observation period. The additional insulin bolus (HFA) normalised triglyceride similarly to low fat 3-6 h following the meal. HF was associated with late postprandial elevations in tumour necrosis factor alpha, whereas LF and HFA was not. Fibrinogen, plasminogen activator inhibitor-1 and tissue factor pathway levels were similar between conditions.
Additional bolus insulin 3 h following a high-carbohydrate high-fat meal prevents late rises in postprandial triglycerides and tumour necrosis factor alpha, thus improving cardiovascular risk profile.
评估在1型糖尿病患者高碳水化合物高脂肪饮食后追加一次速效胰岛素推注对餐后血脂异常、炎症和促凝血作用的影响。
共有10名1型糖尿病男性患者[糖化血红蛋白52.5±5.9 mmol/mol（7.0%±0.5%）]接受了三种情况的测试：（1）低脂（LF）餐并给予常规胰岛素推注；（2）高脂（HF）餐并给予常规胰岛素推注；（3）高脂餐并给予常规胰岛素推注，且在餐后3小时追加30%的胰岛素推注（HFA）。餐食的碳水化合物和蛋白质含量相同，胰岛素推注剂量通过碳水化合物计数法确定。餐后6小时定期采集血液样本，分析甘油三酯、非酯化脂肪酸、载脂蛋白B48、胰高血糖素、肿瘤坏死因子α、纤维蛋白原、人组织因子活性和纤溶酶原激活物抑制剂-1。连续血糖监测记录间质葡萄糖反应。
LF餐后甘油三酯浓度与基线相似，而HF餐后甘油三酯水平在整个6小时观察期内显著更高。额外的胰岛素推注（HFA）使甘油三酯水平在餐后3至6小时恢复正常，与低脂餐情况相似。HF与餐后晚期肿瘤坏死因子α升高有关，而LF和HFA则无此现象。各情况下纤维蛋白原、纤溶酶原激活物抑制剂-1和组织因子途径水平相似。
在高碳水化合物高脂肪餐后3小时追加胰岛素推注可预防餐后甘油三酯和肿瘤坏死因子α的晚期升高，从而改善心血管风险状况。
