加拿大多伦多大学John L Sievenpiper团队研究了低血糖指数/负荷饮食模式对糖尿病患者血糖控制和心脏代谢危险因素的影响。相关论文于2021年8月5日发表于《英国医学杂志》上。
为了了解欧洲糖尿病研究协会营养治疗临床实践指南的更新，研究组在Medline、Embase和Cochrane数据库中检索从建库至2021年5月13日间关于研究低血糖指数（GI）/血糖负荷（GL）饮食对糖尿病的影响，且为期三周及以上的随机对照试验，并进行系统回顾和荟萃分析。
主要结局为糖化血红蛋白（HbA1c）。次要结局包括其他血糖控制指标（空腹血糖、空腹胰岛素）；血脂（低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、非HDL-C、载脂蛋白B、甘油三酯）；肥胖（体重、BMI、腰围）、血压（收缩压(SBP)、舒张压(DBP)）、炎症（C反应蛋白(CRP)）。数据由随机效应模型汇集。
研究组共纳入29项试验，涉及1617名接受高血糖药物或胰岛素治疗的1型和2型糖尿病患者，这些患者多为中度、超重或肥胖，且中度控制2型糖尿病。与高GI/GL对照饮食相比，低GI/GL饮食模式显著降低了HbA1c。空腹血糖、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）、载脂蛋白B、甘油三酯、体重、体重指数（BMI）和C反应蛋白（CRP）也显著降低，但血胰岛素、高密度脂蛋白胆固醇（HDL-C）、腰围或血压没有降低。GL和HbA1c以及膳食绝对GI和SBP的差异呈正剂量-效应梯度。HbA1c降低的证据确定性高，大多数次要结局的证据确定性中等，降低主要是由于不精确。
综合结果表明，除高血糖药物或胰岛素同时治疗外，低GI/GL饮食模式对血糖控制、血脂、肥胖和炎症的既定目标有微小显著改善，这主要发生在中度控制的1型和2型糖尿病成人中。
附：英文原文
Title: Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials
Author: Laura Chiavaroli, Danielle Lee, Amna Ahmed, Annette Cheung, Tauseef A Khan, Sonia Blanco, Mejia, Arash Mirrahimi, David J A Jenkins, Geoffrey Livesey, Thomas M S Wolever, Dario Raheli, Hana Kahleová, Jordi Salas-Salvadó, Cyril W C Kendall, John L Sievenpiper
Issue&Volume: 2021/08/05
Abstract:
Objective To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy.
Design Systematic review and meta-analysis of randomised controlled trials.
Data sources Medline, Embase, and the Cochrane Library searched up to 13 May 2021.
Eligibility criteria for selecting studies Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes.
Outcome and measures The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI, waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)).
Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence.
Results 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference 0.31% (95% confidence interval 0.42 to 0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision.
Conclusions This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population.
DOI: 10.1136/bmj.n1651
Source: https://www.bmj.com/content/374/bmj.n1651
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
