Shibib Lina, Al-Qaisi Mo, Guess Nicola, Miras Alexander D, Greenwald Steve E, Pelling Marc, Ahmed Ahmed
Department of Surgery and Cancer, Imperial College London, London, UK.
Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK.
Diabetes Metab Syndr Obes. 2024 Aug 23;17:3111-3130. doi: 10.2147/DMSO.S458894. eCollection 2024.
This review paper explores post-prandial glycemia in type 2 diabetes. Post-prandial glycemia is defined as the period of blood glucose excursion from immediately after the ingestion of food or drink to 4 to 6 hours after the end of the meal. Post-prandial hyperglycemia is an independent risk factor for cardiovascular disease with glucose "excursions" being more strongly associated with markers of oxidative stress than the fasting or pre-prandial glucose level. High blood glucose is a major promoter of enhanced free radical production and is associated with the onset and progression of type 2 diabetes. Oxidative stress impairs insulin action creating a vicious cycle where repeated post-prandial glucose spikes are key drivers in the pathogenesis of the vascular complications of type 2 diabetes, both microvascular and macrovascular. Some authors suggest post-prandial hyperglycemia is the major cause of death in type 2 diabetes. Proper management of post-prandial hyperglycemia could yield up to a 35% cut in overall cardiovascular events, and a 64% cut in myocardial infarction. The benefits of managing post-prandial hyperglycemia are similar in magnitude to those seen in type 2 diabetes patients receiving secondary prevention with statins - prevention which today is regarded as fundamental by all practitioners. Given all the evidence surrounding the impact of post-prandial glycemia on overall outcome, it is imperative that any considered strategy for the management of type 2 diabetes should include optimum dietary, pharma, and lifestyle interventions that address glucose excursion. Achieving a low post-prandial glucose response is key to prevention and progression of type 2 diabetes and cardiometabolic diseases. Further, such therapeutic interventions should be sustainable and must benefit patients in the short and long term with the minimum of intrusion and side effects. This paper reviews the current literature around dietary manipulation of post-prandial hyperglycemia, including novel approaches. A great deal of further work is required to optimize and standardize the dietary management of post-prandial glycemia in type 2 diabetes, including consideration of novel approaches that show great promise.
这篇综述文章探讨了2型糖尿病患者的餐后血糖情况。餐后血糖被定义为从摄入食物或饮料后即刻到餐后4至6小时的血糖波动期。餐后高血糖是心血管疾病的独立危险因素，与氧化应激标志物的关联比空腹或餐前血糖水平更强。高血糖是自由基产生增加的主要促进因素，与2型糖尿病的发生和发展相关。氧化应激会损害胰岛素作用，从而形成恶性循环，反复出现的餐后血糖峰值是2型糖尿病微血管和大血管并发症发病机制的关键驱动因素。一些作者认为餐后高血糖是2型糖尿病患者死亡的主要原因。妥善管理餐后高血糖可使总体心血管事件减少多达35%，心肌梗死减少64%。管理餐后高血糖的益处与2型糖尿病患者接受他汀类药物二级预防所看到的益处程度相似——如今所有从业者都认为这种预防至关重要。鉴于所有关于餐后血糖对总体结局影响的证据，任何考虑用于管理2型糖尿病的策略都必须包括针对血糖波动的最佳饮食、药物和生活方式干预措施。实现低餐后血糖反应是预防和控制2型糖尿病及心血管代谢疾病的关键。此外，这种治疗干预措施应该是可持续的，并且必须在短期和长期内使患者受益，同时将干扰和副作用降至最低。本文综述了当前有关餐后高血糖饮食控制的文献，包括新方法。在优化和规范2型糖尿病患者餐后血糖的饮食管理方面，包括考虑那些显示出巨大潜力的新方法，还需要大量的进一步研究工作。
