Betônico Carolina C, Cobello Aline Vial, Santos-Bezerra Daniele P, de A Leite André Z, Correa-Giannella Maria Lúcia, Nery Márcia, Queiroz Márcia S
School of Medicine, UNIFAI-Faculdades Adamantinenses Integradas, Adamantina, São Paulo, Brazil.
Nutrition and Dietetics Division, Central Institute of Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
J Diabetes Metab Disord. 2022 Sep 19;21(2):1661-1667. doi: 10.1007/s40200-022-01117-w. eCollection 2022 Dec.
Diabetic gastroparesis (DGP) is an autonomic neuropathy resulting from long-standing poorly controlled diabetes, and it is also linked to fluctuations in glycemic control due to variability on nutrient absorption.
Considering the scarcity of information, the aim of this study was to identify the impact of modifications on diet consistency on post-prandial glucose variability using a continuous glucose monitoring (CGM) and its effect on the perception and severity of gastrointestinal symptoms.
This proof-of-concept study was carried out in a cross-sectional cohort of six individuals with type 1 diabetes mellitus with confirmed diagnosis of DGP. Two types of diet were used to evaluate glycemic control and DGP symptoms, general consistency standard meal (SD) and modified consistency test diet (MD), associated with an application of rapid acting insulin at the time of food intake. Glycemic control was evaluated by CGM, and the Gastroparesis Cardinal Symptom Index (GCSI) was applied after meals.
The CGM curve was different for MD + insulin and SD + insulin. There was a smaller increment of interstitial glucose with 2 h after MD + insulin, returning almost to the basal level 4 h later. Patients scored significantly lower GCSI after MD + insulin compared to the same index after they received SD + insulin. Moreover, there was a decrease in important clinical scores present in the index, like: "Not able to finish meal", "Loss of appetite" and "Stomach or belly feels larger".
This study showed that a modified diet can improve postprandial glycemic excursion and the perception and severity of gastroparesis symptoms.
The online version contains supplementary material available at 10.1007/s40200-022-01117-w.
糖尿病胃轻瘫(DGP)是一种由长期血糖控制不佳的糖尿病引起的自主神经病变,并且它还与由于营养吸收的变异性导致的血糖控制波动有关。
鉴于信息匮乏,本研究的目的是使用连续血糖监测(CGM)来确定饮食稠度改变对餐后血糖变异性的影响及其对胃肠道症状感知和严重程度的影响。
本概念验证研究在一个横断面队列中对6名确诊为DGP的1型糖尿病患者进行。使用两种饮食来评估血糖控制和DGP症状,即一般稠度标准餐(SD)和改良稠度试验饮食(MD),在进食时联合应用速效胰岛素。通过CGM评估血糖控制,并在餐后应用胃轻瘫主要症状指数(GCSI)。
MD +胰岛素组和SD +胰岛素组的CGM曲线不同。MD +胰岛素组餐后2小时组织间葡萄糖的增量较小,4小时后几乎恢复到基础水平。与接受SD +胰岛素后的相同指数相比,患者在MD +胰岛素后GCSI得分显著更低。此外,该指数中存在的重要临床评分有所下降,如:“无法吃完一餐”、“食欲不振”和“胃部或腹部感觉胀大”。
本研究表明,改良饮食可以改善餐后血糖波动以及胃轻瘫症状的感知和严重程度。
在线版本包含可在10.1007/s40200-022-01117-w获取的补充材料。