Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia.
Sci Rep. 2017 Mar 24;7:45286. doi: 10.1038/srep45286.
The gluten free diet (GFD) has a high glycemic index and low-fiber content, which potentially influences glycemic excursions in type 1 diabetes (T1D) and celiac disease (CD). Participants in this case-control study of youth with T1D+CD (n = 10) and T1D only (n = 7) wore blinded continuous glucose monitoring systems for six days. Blood glucose levels (BGLs) were compared between groups for each meal, including pre-meal, peak, 2-hour postprandial and time-to-peak. Participants consumed a test-breakfast of GF cereal and milk for three days and kept weighed food diaries; nutrient intake was analyzed and compared to national recommendations. Youth with T1D+CD had shorter time-to-peak BGL (77 vs 89 mins, P = 0.03), higher peak (9.3 vs 7.3 mmol/L, P = 0.001) and higher postprandial BGLs than T1D (8.4 vs 7.0 mmol/L, P = 0.01), despite similar pre-meal BGLs (9.2 vs 8.6 mmol/L, P = 0.28). Regarding test breakfast, greater pre and post-meal BGL difference correlated with longer CD duration (R = 0.53, P = 0.01). Total energy and macronutrient intake didn't differ between groups; however the majority of participants collectively had inadequate intake of calcium (76%), folate (71%) and fiber (53%), with excessive saturated fat (12%) and sodium (>2,000 mg/day). The GFD is associated with greater glycemic excursions and inadequate nutritional intake in youth with T1D+CD. Clinical management should address both glycemic variability and dietary quality.
无麸质饮食（GFD）的血糖指数高，纤维含量低，这可能会影响 1 型糖尿病（T1D）和乳糜泻（CD）患者的血糖波动。本病例对照研究纳入了 10 名 T1D+CD 青少年患者和 7 名单纯 T1D 患者，参与者在 6 天内佩戴了盲法连续血糖监测系统。比较了两组每顿饭的血糖水平（BGL），包括餐前、峰值、餐后 2 小时和达到峰值的时间。参与者连续三天食用 GF 谷物和牛奶作为测试早餐，并记录称重食物日记；分析营养摄入情况并与国家推荐量进行比较。与 T1D 患者相比，T1D+CD 患者的血糖达到峰值的时间更短（77 分钟 vs 89 分钟，P=0.03），峰值更高（9.3 毫摩尔/升 vs 7.3 毫摩尔/升，P=0.001），餐后血糖更高（8.4 毫摩尔/升 vs 7.0 毫摩尔/升，P=0.01），尽管餐前血糖相似（9.2 毫摩尔/升 vs 8.6 毫摩尔/升，P=0.28）。关于测试早餐，餐前和餐后血糖差值越大，CD 病程越长（R=0.53，P=0.01）。两组的总能量和宏量营养素摄入没有差异；然而，大多数参与者的钙（76%）、叶酸（71%）和纤维（53%）摄入不足，而饱和脂肪（12%）和钠（>2000 毫克/天）摄入过多。GFD 与 T1D+CD 青少年患者的血糖波动更大和营养摄入不足有关。临床管理应同时解决血糖变异性和饮食质量问题。
