Mild Caloric Restriction Decreases Insulin Requirements in Patients With Type 2 Diabetes and Severe Insulin Resistance.
Mild Caloric Restriction Decreases Insulin Requirements in Patients With Type 2 Diabetes and Severe Insulin Resistance.
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DOI：
10.1097/md.0000000000001160
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发表时间：
2015-07
期刊：
影响因子：
1.6
通讯作者：
Brown RJ
中科院分区：
文献类型：
--
作者：
Meehan CA;Cochran E;Mattingly M;Gorden P;Brown RJ
2型糖尿病（T2 D）影响约10%的美国人口，其中一部分人具有严重的胰岛素抵抗（SIR）（>200单位/天）。 用高剂量胰岛素治疗这些患者存在后勤和依从性挑战。我们假设轻度热量限制会减少T2 D和SIR患者的胰岛素需求。这是一项在美国国立卫生研究院临床中心进行的回顾性研究。入选标准如下：T2 D，且胰岛素剂量>200单位/天或>2单位/kg/天。 干预措施包括在3至6天的住院期间轻度热量限制。主要转归为入院至出院期间胰岛素剂量和血糖的变化。10例患者符合入选标准。基线糖化血红蛋白A1 c为10.0 ± 1.6%，体重指数为38.8 ± 9.0 kg/m2。 食物摄入量从入院前的2210± 371 kcal/d限制到住院期间的1810±202 kcal/d（减少16.5%）。 胰岛素剂量从入院前的486± 291单位/天降至出院时的223±127单位/天（减少44%，P = 0.0025）。 血糖在空腹状态（从184 ± 85降至141 ± 42，P = 0.20）、午餐前（239 ± 68降至180 ± 76，P = 0.057）和睡前（212 ± 95降至176 ± 48，P = 0.19）无显著性降低，晚餐前（222 ± 92降至162 ± 70，P = 0.016）显著降低。 轻度热量限制是一种可获得且负担得起的干预措施，可大幅降低T2 D和SIR患者的胰岛素剂量。需要进一步的研究来确定干预和结果是否在医院环境之外可持续。
Type 2 diabetes (T2D) affects ∼10% of the US population, a subset of whom have severe insulin resistance (SIR) (>200 units/d). Treatment of these patients with high-dose insulin presents logistical and compliance challenges. We hypothesized that mild caloric restriction would reduce insulin requirements in patients with T2D and SIR. This was a retrospective study at the National Institutes of Health Clinical Center. Inclusion criteria were as follows: T2D, and insulin dose >200 units/d or >2 units/kg/d. The intervention consisted of mild caloric restriction during a 3 to 6-day hospitalization. The major outcomes were change in insulin dose and blood glucose from admission to discharge. Ten patients met inclusion criteria. Baseline glycated hemoglobin A1c was 10.0 ± 1.6% and body mass index 38.8 ± 9.0 kg/m2. Food intake was restricted from 2210 ± 371 kcal/d preadmission to 1810 ± 202 during the hospital stay (16.5% reduction). Insulin dose decreased from 486 ± 291 units/d preadmission to 223 ± 127 at discharge (44% reduction, P = 0.0025). Blood sugars decreased nonsignificantly in the fasting state (from 184 ± 85 to 141 ± 42, P = 0.20), before lunch (239 ± 68 to 180 ± 76, P = 0.057), and at bedtime (212 ± 95 to 176 ± 48, P = 0.19), and significantly decreased before dinner (222 ± 92 to 162 ± 70, P = 0.016). Mild caloric restriction, an accessible and affordable intervention, substantially reduced insulin doses in patients with T2D and SIR. Further studies are needed to determine if the intervention and results are sustainable outside of a hospital setting.