Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
Diabetes Care. 2020 Jan;43(1):59-66. doi: 10.2337/dc19-0687. Epub 2019 Aug 27.
The American Diabetes Association recommends individuals with type 1 diabetes (T1D) adjust insulin for dietary fat; however, optimal adjustments are not known. This study aimed to determine ) the relationship between the amount and type of dietary fat and glycemia and ) the optimal insulin adjustments for dietary fat.
Adults with T1D using insulin pump therapy attended the research clinic on 9-12 occasions. On the first six visits, participants consumed meals containing 45 g carbohydrate with 0 g, 20 g, 40 g, or 60 g fat and either saturated, monounsaturated, or polyunsaturated fat. Insulin was dosed using individual insulin/carbohydrate ratio as a dual-wave 50/50% over 2 h. On subsequent visits, participants repeated the 20-60-g fat meals with the insulin dose estimated using a model predictive bolus, up to twice per meal, until glycemic control was achieved.
With the same insulin dose, increasing the amount of fat resulted in a significant dose-dependent reduction in incremental area under the curve for glucose (iAUC) in the early postprandial period (0-2 h; = 0.008) and increase in iAUC in the late postprandial period (2-5 h; = 0.004). The type of fat made no significant difference to the 5-h iAUC. To achieve glycemic control, on average participants required dual-wave insulin bolus: for 20 g fat, +6% insulin, 74/26% over 73 min; 40 g fat, +6% insulin, 63/37% over 75 min; and 60 g fat, +21% insulin, 49/51% over 105 min.
This study provides clinical guidance for mealtime insulin dosing recommendations for dietary fat in T1D.
美国糖尿病协会建议 1 型糖尿病（T1D）患者调整胰岛素以适应饮食中的脂肪量；然而，最佳调整方案尚不清楚。本研究旨在确定：（1）饮食中脂肪量和类型与血糖之间的关系；以及（2）针对饮食中脂肪进行胰岛素调整的最佳方案。
使用胰岛素泵治疗的 T1D 成年患者在研究诊所就诊 9-12 次。在前六次就诊中，参与者分别进食含 45 g 碳水化合物的餐食，同时摄入 0 g、20 g、40 g 或 60 g 的脂肪，以及饱和脂肪、单不饱和脂肪或多不饱和脂肪。使用个体胰岛素/碳水化合物比值，在 2 小时内以 50/50%的双波方式给与胰岛素剂量。在随后的就诊中，参与者使用模型预测推注估算胰岛素剂量，重复进食 20-60 g 脂肪餐，每餐最多重复两次，直至实现血糖控制。
使用相同的胰岛素剂量，随着脂肪量的增加，餐后早期（0-2 小时）葡萄糖增量曲线下面积（iAUC）呈显著的剂量依赖性降低（ = 0.008），餐后晚期（2-5 小时）iAUC 增加（ = 0.004）。脂肪类型对 5 小时 iAUC 没有显著差异。为了实现血糖控制，参与者平均需要双波胰岛素推注：20 g 脂肪时，增加 6%胰岛素，73 分钟内 74/26%；40 g 脂肪时，增加 6%胰岛素，75 分钟内 63/37%；60 g 脂肪时，增加 21%胰岛素，105 分钟内 49/51%。
本研究为 T1D 患者的饮食脂肪的餐时胰岛素剂量推荐提供了临床指导。
