Department of Molecular Medicine and Medical Biotechnology, Federico II University, 80131 Naples, Italy.
Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
Nutrients. 2019 Jul 10;11(7):1559. doi: 10.3390/nu11071559.
The achievement of optimal post-prandial (PP) glucose control in patients with type 1 diabetes (T1DM) remains a great challenge. This review summarizes the main factors contributing to PP glucose response and discusses the likely reasons why PP glucose control is rarely achieved in T1DM patients. The macronutrient composition of the meal, the rate of gastric emptying and premeal insulin administration are key factors affecting the PP glucose response in T1DM. Although the use of continuous insulin infusion systems has improved PP glucose control compared to conventional insulin therapy, there is still need for further ameliorations. T1DM patients frequently present a delayed gastric emptying (GE) that produces a lower but more prolonged PP hyperglycemia. In addition, delayed GE is associated with a longer time to reach the glycemic peak, with a consequent mismatch between PP glucose elevation and the timing of premeal insulin action. On this basis, including GE time and meal composition in the algorithms for insulin bolus calculation of the insulin delivery systems could be an important step forward for optimization of PP glucose control in T1DM.
实现 1 型糖尿病（T1DM）患者餐后（PP）血糖的最佳控制仍然是一个巨大的挑战。本文综述了影响 PP 血糖反应的主要因素，并讨论了为什么 T1DM 患者很少能达到 PP 血糖控制的原因。餐食的宏量营养素组成、胃排空率和餐前胰岛素给药是影响 T1DM 患者 PP 血糖反应的关键因素。尽管与常规胰岛素治疗相比，连续胰岛素输注系统的使用改善了 PP 血糖控制，但仍需要进一步改善。T1DM 患者常出现胃排空延迟（GE），导致餐后血糖升高较低但持续时间更长。此外，GE 延迟与达到血糖峰值的时间延长有关，从而导致 PP 血糖升高与餐前胰岛素作用时间不匹配。在此基础上，将 GE 时间和膳食组成纳入胰岛素输注系统胰岛素推注计算算法中，可能是优化 T1DM 患者 PP 血糖控制的重要一步。
