Toschi Elena, Edwards Stephanie, Kao Christi Y, Xue Jie, Atakov-Castillo Astrid, Wang Wenjie, Steil Garry, Wolpert Howard
Joslin Diabetes Center, Boston, Massachusetts, USA.
Eli Lilly and Company, Indianapolis, Indiana, USA.
Diabetes Technol Ther. 2025 Jan;27(1):66-71. doi: 10.1089/dia.2024.0132. Epub 2024 Aug 22.
Optimizing postprandial glucose control in persons with type 1 diabetes (T1D) is challenging. We hypothesized that in free-living individuals, meal composition (high and low glycemic index [HGI and LGI], high and low fat [HF and LF]) may impact insulin requirements. Adults ( = 25) with T1D using open-loop insulin and continuous glucose monitoring were provided a meal-tagging app and prepackaged meals with defined macronutrient content. Data from 463 meals were analyzed. LGI meals required significantly more insulin than HGI meals ( = 0.01). Furthermore, the mean (±standard deviation) carbohydrate-to-insulin ratio (CIR) was significantly different overall among the LGI-LF (5.5 ± 3.4), LGI-HF (4.5 ± 3.8), HGI-LF (7.6 ± 5.1), and HGI-HF (8.7 ± 5.8) meals ( = 0.001). The risk of nocturnal hypoglycemia is associated with daytime hypoglycemia and amount of insulin administered prior to the evening and exercise. This exploratory study designed to examine the impact of different meal types on insulin dosing requirements in free-living adults with T1D emphasizes the need for individualized adjustment of the CIR depending on meal composition.
优化1型糖尿病（T1D）患者的餐后血糖控制具有挑战性。我们假设，在自由生活的个体中，膳食组成（高和低血糖指数[HGI和LGI]、高脂肪和低脂肪[HF和LF]）可能会影响胰岛素需求。为使用开环胰岛素和持续葡萄糖监测的25名成年T1D患者提供了一款膳食标记应用程序以及含有特定宏量营养素含量的预包装膳食。对463份膳食的数据进行了分析。LGI膳食比HGI膳食需要显著更多的胰岛素（P = 0.01）。此外，LGI-LF（5.5±3.4）、LGI-HF（4.5±3.8）、HGI-LF（7.6±5.1）和HGI-HF（8.7±5.8）膳食的平均（±标准差）碳水化合物与胰岛素比值（CIR）总体上有显著差异（P = 0.001）。夜间低血糖风险与白天低血糖以及傍晚和运动前注射的胰岛素量有关。这项旨在研究不同膳食类型对自由生活的成年T1D患者胰岛素给药需求影响的探索性研究强调，需要根据膳食组成对CIR进行个体化调整。
