基于食物的营养教育、碳水化合物计数或常规护理对 1 型糖尿病的影响：12 个月前瞻性随机试验。
Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial.
机构信息
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Medicine, NU Hospital Group, Uddevalla, Sweden.
出版信息
BMJ Open Diabetes Res Care. 2021 Mar;9(1). doi: 10.1136/bmjdrc-2020-001971.
INTRODUCTION
Evidence on the effects of structured nutrition education is weak in adults with type 1 diabetes mellitus (T1D) with moderately impaired glycemic control. Objective was to compare the effects of different types of nutrition education programs on glycemic control, cardiovascular risk factors, quality of life, diet quality and food choices in T1D.
RESEARCH DESIGN AND METHODS
A 12 months randomized controlled study conducted at nine diabetes specialist centers with three parallel arms: (i) a food-based approach (FBA) including foods with low glycemic index or (ii) carbohydrate counting (CC) according to today's standard practice or (iii) individual sessions according to routine care (RC). The primary end point was difference in glycated hemoglobin A1c (HbA1c) between groups at 12 months.
RESULTS
159 patients were randomized (FBA: 51; CC: 52; RC: 55). Mean (SD) age 48.6 (12.0) years, 57.9% females and mean (SD) HbA1c level 63.9 (7.9) mmol/mol, 8% (0.7%). After 3 months, HbA1c improved in both FBA and CC compared with RC. However, there were no significant differences at 12 months in HbA1c; FBA versus RC (-0.4 mmol/mol (1.3), 0.04% (0.1%)), CC versus RC (-0.8 mmol/mol (1.2), 0.1% (0.1%)), FBA versus CC (0.4 mmol/mol (0.3), 0.04% (0.01%)). At 12 months, intake of legumes, nuts and vegetables was improved in FBA versus CC and RC. FBA also reported higher intake of monounsaturated and polyunsaturated fats compared with RC, and dietary fiber, monounsaturated and polyunsaturated fats compared with CC (all p values <0.05). There were no differences in blood pressure levels, lipids, body weight or quality of life.
CONCLUSIONS
Nutrition education using an FBA, CC or RC is equivalent in terms of HbA1c and cardiovascular risk factors in persons with T1D with moderately impaired glycemic control. An FBA had benefits regarding food choices compared with CC and RC.
简介
在血糖控制中度受损的 1 型糖尿病（T1D）成人中，关于结构化营养教育效果的证据较为薄弱。本研究旨在比较不同类型的营养教育计划对 T1D 患者血糖控制、心血管风险因素、生活质量、饮食质量和食物选择的影响。
研究设计和方法
这是一项在 9 个糖尿病专科中心进行的为期 12 个月的随机对照研究，共分为 3 个平行组：（i）基于食物的方法（FBA），包括低血糖指数的食物，或（ii）根据当前标准实践的碳水化合物计数（CC），或（iii）根据常规护理的个体化课程（RC）。主要终点是各组在 12 个月时糖化血红蛋白 A1c（HbA1c）的差异。
结果
共纳入 159 例患者（FBA：51 例；CC：52 例；RC：55 例）。平均（标准差）年龄为 48.6（12.0）岁，女性占 57.9%，平均（标准差）HbA1c 水平为 63.9（7.9）mmol/mol，8%（0.7%）。与 RC 相比，FBA 和 CC 组在 3 个月时 HbA1c 均有所改善。然而，12 个月时，FBA 与 RC（-0.4 mmol/mol（1.3），0.04%（0.1%））、CC 与 RC（-0.8 mmol/mol（1.2），0.1%（0.1%））、FBA 与 CC（0.4 mmol/mol（0.3），0.04%（0.01%））之间的 HbA1c 差异均无统计学意义。在 12 个月时，FBA 组与 CC 和 RC 组相比，豆类、坚果和蔬菜的摄入量增加。与 RC 相比，FBA 组还报告了更高的单不饱和脂肪和多不饱和脂肪摄入量，与 CC 相比，FBA 组还报告了更高的膳食纤维、单不饱和脂肪和多不饱和脂肪摄入量（所有 p 值均＜0.05）。三组间血压水平、血脂、体重或生活质量无差异。
结论
在血糖控制中度受损的 T1D 患者中，采用 FBA、CC 或 RC 的营养教育在 HbA1c 和心血管风险因素方面效果相当。与 CC 和 RC 相比，FBA 在食物选择方面具有优势。
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