Department of Endocrinology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine, Nanjing 210014, China.
Department of Integrated Traditional Chinese and Western Medicine, East Region Military Command General Hospital, Nanjing 210012, China.
Prim Care Diabetes. 2022 Jun;16(3):368-374. doi: 10.1016/j.pcd.2022.03.007. Epub 2022 Mar 21.
In view of the complexity of dietary and nutritional education for most patients with type 2 diabetes mellitus (T2DM), a simplified approach called the "restricted diet with a plate" or "plate model" is recommended.
To evaluate whether the plate model can effectively improve glycemic control and cardiovascular risk markers in type 2 diabetes mellitus (T2DM), while reducing the time devoted to education and avoiding weight gain.
The study was a randomized, multicenter, controlled study, conducted between October 2018 and October 2019, among patients with T2DM living in Nanjing. The study included 419 participants who were randomly divided into a plate group and a counting group. The plate model included three components: a low-literacy, color leaflet containing the explanation and composition of the plate model, health education, and medical visits. Patients in the counting group received health education, group medical visits, and a paper booklet containing traditional carbohydrate counting education. Primary outcomes were glycemic control and weight.
Participants in the plate model reduced HbA by 0.7% in the first three months, and reduced to a greater extent at six months (1.44%), but this was not sustained, and HbA increased slightly over the following six months. Fasting plasma glucose (FPG) and 2-h postprandial glucose (2hPG) values were significantly reduced at the endpoint in the plate model (9.25 ± 1.72% vs. 7.44 ± 0.88%, P = 0.008; 12.07 ± 2.94 vs. 8.35 ± 1.99%; P = 0.004); however, the 2hPG values decreased most significantly. Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly in the plate group, which occurred at six months and lasted for 12 months. In the first three months, the average weight loss in the plate group was 1.2 kg/month (95% CI 0.92-1.48), and in the fourth to twelfth months, the average weight gain was 0.21 kg/month (95% CI 0.08-0.34). There was significant difference in education time between the groups (17.3 ± 4.42 vs. 38.6 ± 12.63; P < 0.001).
The plate model is at least as effective as the counting model over the short term for glycemic control and perhaps even better for weight and lipid control. Plate model has the potential to improve education of those with low health literacy by reducing reading demands.
鉴于大多数 2 型糖尿病（T2DM）患者的饮食和营养教育较为复杂，建议采用一种简化方法，即“限制饮食餐盘”或“餐盘模型”。
评估餐盘模型是否能有效改善 2 型糖尿病（T2DM）患者的血糖控制和心血管风险标志物，同时减少教育时间并避免体重增加。
这是一项于 2018 年 10 月至 2019 年 10 月间在南京开展的、针对 T2DM 患者的随机、多中心、对照研究。共纳入 419 名参与者，随机分为餐盘组和计数组。餐盘模型包括三个组成部分：一份低文化素养、彩色的传单，包含餐盘模型的解释和组成、健康教育和医疗访视。计数组接受健康教育、小组医疗访视和一本包含传统碳水化合物计数教育的纸质小册子。主要结局指标为血糖控制和体重。
餐盘模型组患者在最初三个月内 HbA1c 降低了 0.7%，在六个月时降低幅度更大（1.44%），但这一效果并未持续，之后六个月内 HbA1c 略有升高。餐盘模型组在终点时空腹血糖（FPG）和餐后 2 小时血糖（2hPG）值显著降低（9.25±1.72% vs. 7.44±0.88%，P=0.008；12.07±2.94 vs. 8.35±1.99%，P=0.004）；但 2hPG 值降低最显著。餐盘组总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平在六个月时显著降低，并持续至 12 个月。在最初三个月内，餐盘组的平均体重每月减轻 1.2 公斤（95%CI 0.92-1.48），而在第四至第十二个月内，平均体重每月增加 0.21 公斤（95%CI 0.08-0.34）。两组的教育时间有显著差异（17.3±4.42 与 38.6±12.63；P<0.001）。
餐盘模型在短期内对血糖控制的效果至少与计数模型相当，甚至在体重和血脂控制方面可能更好。餐盘模型通过降低阅读需求，有可能改善低健康素养人群的教育效果。
