目的 探讨不同医学营养治疗方法 对老年2型糖尿病(T2DM)患者胰岛素抵抗的影响.方法将85例T2DM患者按完全随机分组法分为三组,对照组29例、低血糖生成指数膳食组27例、水溶性膳食纤维组29例,三组均参照中国糖尿病医学营养治疗指南编制糖尿病(DM)膳食食谱,并给予口服降糖药,低血糖生成指数膳食组早晚餐完全用低血糖生成指数膳食替代,水溶性膳食纤维组在早、晚餐时各添加水溶性膳食纤维10 g.干预期1个月,干预前后观察各组患者血糖、血脂、肾功能及胰岛素抵抗情况.结果 与干预前比较,各组干预后血糖均有不同程度下降(P<0.05),低血糖生成指数膳食组及水溶性膳食纤维组干预后胰岛素抵抗指标下降(P<0.05).与对照组比较,干预后低血糖生成指数膳食组和水溶性膳食纤维组胰岛素抵抗明显低于对照组(P<0.05).结论 老年T2DM患者在DM膳食谱及口服药物治疗基础上,给予低血糖生成指数膳食替代治疗或添加水溶性膳食纤维,能有效控制血糖水平,降低胰岛素抵抗.

Objective To investigate the effects of different medical nutrition therapy on blood glucose variability in elderly patients with type 2 diabetes .Methods Eighty‐five patients with type 2 diabetes were randomly divided into three groups ,29 cases in the control group ,27 cases in the low GI diet group ,29 cases in water‐soluble dietary fiber group .Each patient was established a individuality diabetic diet recipe according to the guidelines of medical nutrition therapy ,combined with oral hypoglycemic agents , The breakfast and dinner for patients in low GI diet group were completely instead of low GI diet ,while the breakfast and dinner for patients in water‐soluble dietary fiber group were added 10 g dietary fiber .Blood glucose ,blood lipid ,renal function and blood glu‐cose fluctuation were observed before and after one‐month intervention .Results Compared with before intervention ,the concentra‐tion of blood glucose after the intervention in each group were decreased (P < 0 .05) ,the glucose fluctuation index in low GI diet group and water soluble dietary fiber group decreased obviously after the intervention (P< 0 .05) .After the intervention ,average fasting blood glucose ,postprandial glucose average ,and mean blood glucose in low GI diet group were significantly lower than those in control group (P< 0 .05) ,Meanwhile ,the blood sugar standard deviation and MAGE in low GI dietary intervention group and in water‐soluble dietary fiber group were significantly lower than that of control group (P< 0 .05) .Conclusion On the basis of the di‐abetes diet recipes and oral drug treatment giving low GI dietary replacement therapy or adding water soluble dietary fiber ,for eld‐erly patients with type 2 diabetes ,could effectively control the blood glucose level ,and significantly reduce glucose variability .