Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.
Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
Nutr Diabetes. 2022 Apr 22;12(1):24. doi: 10.1038/s41387-022-00201-7.
Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment.
Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes.
The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance.
From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI.
Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.
医学营养疗法（MNT）在糖尿病整体管理中具有重要作用。在青春期，考虑到生理和心理社会变化对于实施最佳糖尿病治疗至关重要。
我们旨在确定、总结和解释关于 1 型糖尿病青少年 MNT 的已发表文献。
从 1959 年 1 月至 2021 年 12 月，我们在 Medline（PubMed）和 EMBASE 数据库中进行了检索。纳入标准为针对 1 型糖尿病青少年的 MNT 干预研究，疾病持续时间超过 1 年，包括以下结局：饮食摄入量和每日进食模式（使用经过验证的工具评估，两次或更多 24 小时膳食回忆或 3 天膳食记录）、糖尿病自我管理教育和支持（DSMES）、血糖控制、血脂谱和体重指数（BMI）。排除标准为无对照组的研究（除前后研究外）、无随机分组以及仅评估单一营养素、食物或餐次摄入的研究，以及综述和体内/体外研究。使用 Cochrane 随机试验偏倚风险工具对偏倚风险进行评估。采用叙述性综合法呈现结果。使用 GRADE 指南评估证据质量。
从总共 5377 条记录中，纳入了 12 项干预研究（9 项 RCT 和 3 项前后干预研究）。由于研究之间存在很大的异质性，因此对这些数据进行了荟萃分析。这些研究关于 MNT 对饮食模式、DSMES、血糖控制、血脂谱和 BMI 的有效性的结果存在冲突。
关于 1 型糖尿病青少年 MNT 有效性的临床研究较少。具有高偏倚风险的研究数量有限，无法就这一问题得出可靠的结论。需要进一步的研究。
