Diabetes Care：低碳水化合物治疗对妊娠糖尿病无效

基于碳水化合物（CHO）分布和数量控制的医学营养治疗是妊娠糖尿病（GDM）的初始治疗，但是，需要随机对照试验对不同的饮食策略进行比较。为了探讨GDM治疗中的低CHO饮食与正常饮食相比，是否可以导致相似的妊娠结局下更低的胰岛素治疗使用率，来自西班牙莱里达大学医院内分泌与营养科的Didac Mauricio教授及其团队进行了一项研究，该研究结果在线发表在2013年4月5日的《糖尿病治疗》（Diabetes Care）杂志上。该研究发现GDM的治疗中使用低CHO饮食不能减少需要使用胰岛素治疗的患者数量，并产生相似的妊娠结局。在GDM，CHO量（总热量的40 vs 55%）不影响胰岛素的需求或妊娠结局。

该研究是一项开放的、随机对照试验，共包括152例GDM女性，并被分配到接受低CHO含量的饮食（CHO占总膳食能量的40%）或对照饮食（CHO占总膳食能量的55%）。通过3日饮食记录法对CHO摄入进行评估。并且评估主要的妊娠结局。

该研究结果表明，两个治疗组之间，需要使用胰岛素女性的比例没有明显差异（低CHO 54.7% vs 对照组54.7%；P=1）。饮食记录确认两组间CHO消耗量由差异（P=0.0001）。两个治疗组之间产科和围产期结局没有发现差异。

该研究发现，GDM的治疗中使用低CHO饮食不能减少需要使用胰岛素治疗的患者数量，并产生相似的妊娠结局。在GDM，CHO量（总热量的40 vs 55%）不影响胰岛素的需求或妊娠结局。

Low-Carbohydrate Diet for the Treatment of Gestational Diabetes: A randomized controlled trial.
OBJECTIVE
Medical nutrition therapy based on the control of the amount and distribution of carbohydrates (CHO) is the initial treatment for gestational diabetes mellitus (GDM), but there is a need for randomized controlled trials comparing different dietary strategies. The purpose of this study was to test the hypothesis that a low-CHO diet for the treatment of GDM would lead to a lower rate of insulin treatment with similar pregnancy outcomes compared with a control diet.
RESEARCH DESIGN AND METHODS
A total of 152 women with GDM were included in this open, randomized controlled trial and assigned to follow either a diet with low-CHO content (40% of the total diet energy content as CHO) or a control diet (55% of the total diet energy content as CHO). CHO intake was assessed by 3-day food records. The main pregnancy outcomes were also assessed.
RESULTS
The rate of women requiring insulin was not significantly different between the treatment groups (low CHO 54.7% vs. control 54.7%; P = 1). Daily food records confirmed a difference in the amount of CHO consumed between the groups (P = 0.0001). No differences were found in the obstetric and perinatal outcomes between the treatment groups.
CONCLUSIONS
Treatment of women with GDM using a low-CHO diet did not reduce the number of women needing insulin and produced similar pregnancy outcomes. In GDM, CHO amount (40 vs. 55% of calories) did not influence insulin need or pregnancy outcomes.