新饮食模式有望使2型糖尿病患者停药

2019-12-05 转网 转化医学网

近日,以色列特拉维夫大学的一项临床研究发现(NCT02709915),通过采用一种新的饮食模式,可调节2型糖尿病患者生物钟基因的表达,有希望使患者减少甚至停止胰岛素注射以及大多数抗糖尿病药物,同时实现血糖水平的良好控制。该饮食干预模式,即“3M”饮食,主要特点为高碳水化合物的早餐和低碳水化合物的晚餐。近年来越来越多的研究显示,饮食规律会影响生物钟,进而影响健康和疾病的发生。而且,晚上人体并不适于代

近日,以色列特拉维夫大学的一项临床研究发现(NCT02709915),通过采用一种新的饮食模式,可调节2型糖尿病患者生物钟基因的表达,有希望使患者减少甚至停止胰岛素注射以及大多数抗糖尿病药物,同时实现血糖水平的良好控制。

该饮食干预模式,即“3M”饮食,主要特点为高碳水化合物的早餐和低碳水化合物的晚餐。

近年来越来越多的研究显示,饮食规律会影响生物钟,进而影响健康和疾病的发生。而且,晚上人体并不适于代谢高热量、高碳水化合物的饮食。相反,早上采用高热量、高碳水化合物的饮食可提高胰岛素敏感性,降低肥胖人群和糖尿病患者的总体血糖水平。

传统的糖尿病饮食建议为每天六次的少量饮食(six-meal diet,6Mdiet),即多次少量分布均匀的饮食模式,比如每天三餐和三份零食,其中睡前的一份零食用来防止夜间血糖水平过低。

6M饮食模式并不能有效控制血

糖,因此糖尿病患者需要额外的药物和胰岛素。

但是,对于糖尿病患者,胰岛素注射会导致体重增加,从而进一步导致血糖水平升高,并会导致心血管疾病和其它并发症。

研究人员假设通过3M(three-meal diet,3Mdiet)饮食模式和胰岛素治疗,可调节2型糖尿病患者的生物钟基因的表达,进而有效的降低体重和食欲,改善血糖控制,最终降低每天胰岛素总剂量(total daily insulin dose ,TDID)。3M饮食主要特点为高碳水化合物的早餐和低碳水化合物的晚餐。这一模式与6M饮食结构有着显着的不同,6M饮食的主要营养物质在一天中分布均匀,而3M饮食的主要营养物质在每天的前几个小时。

为验证该假设,研究人员将3M饮食与传统6M饮食进行了比较。该3M饮食为:早餐为面包、水果和糖果,丰盛的午餐,低碳水化合物、水果和糖果的晚餐。

研究人员将28名糖尿病患者(BMI 32.4±5.2kg/m2,HbA1c 8.1±1.1%[64.5±11.9mmol/mol])随机分为3M和6M两组。分别在基线、2周后和12周后三个时间点进行评估,评估指标有体重、血糖、连续血糖值监测(continuous glucose monitoring, CGM)、食欲和生物钟基因表达水平。

结果表明,3M组(而非6M)12周后体重显着下降(-5.4±0.9 kg)(P<0.01),糖化血红蛋白下降(-12 mmol/mol[-1.2%])(P<0.0001)。而且,3M组的空腹血糖、每日和夜间血糖水平显着降低。连续血糖值监测显示,仅3M组的高血糖时间显着减少。仅3M组每日胰岛素总剂量显着减少26±7单位,饥饿感和食欲显着降低。与6M组相比,3M组的时钟基因表现出节律性、表达增加和振幅增加。

3M饮食和6M饮食的三种葡萄糖水平(<3.9mmol/L,3.9-10 mmol/L,>10 mmol/L)比例在每天(24 h)和夜间(00:00–06:00 )比例,分别在基线水平、2周和12周检测

生物钟相关基因的表达能促进胰岛素分泌、改善血糖向肌肉的转运,以及平衡白天和夜间的葡萄糖代谢。因此,3M饮食导致的生物钟相关基因表达的上调可能是其成功的关键。

3M饮食使患者对糖尿病药物的需求,特别是胰岛素剂量的需求大幅下降。有些人甚至可以完全停用胰岛素。此外,3M饮食提高了生物钟基因的表达。这表明3M饮食不仅可以控制糖尿病,还可以预防许多其它并发症,如心血管疾病、衰老和癌症。

参考文献:

Daniela Jakubowicz et al, Reduction in Glycated Hemoglobin and Daily Insulin Dose Alongside Circadian Clock Upregulation in Patients With Type 2 Diabetes Consuming a Three-Meal Diet: A Randomized Clinical Trial, Diabetes Care (2019). DOI: 10.2337/dc19-1142

https://medicalxpress.com/news/2019-12-sync-biological-clock-problematic-diabetes.html

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    2019-12-07 yinhl1980
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    2019-12-06 misszhang

    谢谢MedSci提供最新的资讯

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SGLT2(钠-葡萄糖共转运体2)抑制剂可降低2型糖尿病患者的心血管事件,但其是否对心脏有直接的促进作用尚不明确。Verma等人开展一项研究,探究依帕列净是否可降低2型糖尿病合并冠心病患者的左心室(LV)重量。2016年11月-2018年4月,共招募了97位40岁-80岁的、糖化血红蛋白 6.5%~10.0%、估算肾小球滤过率≥60 mL/min/1.73m2的冠心病患者,随机分至依帕列净组(10

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由此可见,面包中全麦结构的完整性是血糖反应的决定因素。这些发现对饮食建议和“全麦”一词的定义都有影响。

Diabetes Care:非白蛋白尿CKD的2型糖尿病患者肾脏功能快速下降、全因死亡和MACE的风险

由此可见,非白蛋白尿CKD患者的eGFR下降速率比其他任何组均慢。然而,与没有CKD的个体相比,这些人仍然具有更大的死亡和MACE风险。

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由此可见,长期使用低剂量阿司匹林可以降低T2D女性患者痴呆症的风险。