Feng Yan, Yu Quan, Gu Fuqian, Feng Qi, Zhang Yinghong
Department of Clinical Nutrition, Yuhuangding Hospital Affiliated to Qingdao University, Yantai, China.
Department of Clinical Nutrition, Jinshan Hospital Affiliated to Fudan University, Shanghai, China.
Front Nutr. 2024 Nov 20;11:1450127. doi: 10.3389/fnut.2024.1450127. eCollection 2024.
Conducted a one-day outpatient service for GDM patients, analyzed the relationship between stress adaptation disorder and insulin resistance in GDM patients after intervention, and tried to provide some new clues for the prevention and treatment of GDM, provide some theoretical basis for the multidisciplinary diagnosis and treatment model of GDM patients.
240 GDM women were included in this study, 120 women were included in one-day diabetes clinic management for GDM women as GDM Intervention Group, and 120 GDM women receiving regular dietary education as GDM Control Group. One-day diabetes clinic management including disease knowledge and dietary education, sports education and blood sugar monitoring and personalized issues and follow-up visits, and intervention time lasting for 1 month.
After intervention, the concentration of 2-h postprandial blood glucose, and HOMA-IR were decreased in GDM Intervention Group, while weekly weight gain rate and insulin application rate were significantly lower than GDM Control Group (all < 0.05). Cortisol and MDA in GDM Intervention Group were significantly lower than GDM Control Group (both < 0.01). HOMA-IR was positively correlated with weight gain, E, NE and cortisol ( = 0.249, 0.242, 0.663, 0.313, all < 0.01), E and HOMA-IR were negatively correlated with SOD in GDM Intervention Group ( = -0.306, -0.213, both < 0.01).
The intervention model in our study was based on the one-day outpatient comprehensive management model of diabetes, which improved the insulin resistance of GDM patients. The possible mechanism was related to the implementation of one-day outpatient intervention measures, which reduced the stress adaptation disorder and oxidative stress injury of GDM patients. At the same time, the implementation of intervention measures reduced the rate of weight gain, which can also alleviate insulin resistance to a certain extent. One-day outpatient treatment has a positive effect on improving insulin resistance in GDM women, which can reduce the risk of maternal and fetal complications.
为妊娠期糖尿病(GDM)患者开展一日门诊服务,分析干预后GDM患者应激适应障碍与胰岛素抵抗的关系,试图为GDM的防治提供新线索,为GDM患者多学科诊疗模式提供理论依据。
本研究纳入240例GDM女性,其中120例女性纳入GDM一日糖尿病门诊管理作为GDM干预组,120例接受常规饮食教育的GDM女性作为GDM对照组。一日糖尿病门诊管理包括疾病知识与饮食教育、运动教育、血糖监测及个性化问题与随访,干预时间持续1个月。
干预后,GDM干预组餐后2小时血糖浓度及稳态模型评估的胰岛素抵抗(HOMA-IR)降低,而每周体重增加率和胰岛素应用率显著低于GDM对照组(均P<0.05)。GDM干预组皮质醇和丙二醛水平显著低于GDM对照组(均P<0.01)。GDM干预组HOMA-IR与体重增加、肾上腺素(E)、去甲肾上腺素(NE)和皮质醇呈正相关(r=0.249、0.242、0.663、0.313,均P<0.01),E和HOMA-IR与超氧化物歧化酶(SOD)呈负相关(r=-0.306、-0.213,均P<0.01)。
本研究的干预模式基于糖尿病一日门诊综合管理模式,改善了GDM患者的胰岛素抵抗。可能机制与一日门诊干预措施的实施有关,该措施降低了GDM患者的应激适应障碍和氧化应激损伤。同时,干预措施的实施降低了体重增加率,也能在一定程度上减轻胰岛素抵抗。一日门诊治疗对改善GDM女性胰岛素抵抗有积极作用,可降低母婴并发症风险。