| In2010, the New England journal of medicine reported the prevalence of diabetes and pre-diabetes were9.7%and15.5%in China respectively, which means that our country had92.4million diabetic patients and148million people prediabetic condition. The study found that IGR stage already exist cardiovascular disease and diabetes microvascular complications, lifestyle changes in IGR and early type2DM patients can not only reduce the outcome rate of IGR to type2diabetes, still can delay IGR and early type2DM patients complications development.Low GI diet is a hotspot in the research of chronic disease prevention in recent years, the core of which is to contain the same amount of carbohydrate in different food, its digestive absorption rate and blood glucose response level is not the same. The glucose of Low GI diet releases slowly, which reduces the postprandial blood sugar peak value and insulin level, increases glucose intake utilization ratio of outside tissues, which is helpful for blood sugar control, reducing insulin resistance. Meal replacement is to pre-process making good to meet a certain people need nutrition healthy dietary direct replacement part or all of the cafeteria food. In recent years abroad study shows that dietary replacement is economic, security, and good for subjects obedience, can avoid the fault of regular diet intervention appeared in disconnection between theory and practice.This research will connect low GI diet with dietary replacement method, supplemented by health education, sports guidance, blood sugar monitoring, and other means, to intervent IGR and type2diabetic subjects in the communities, and evaluate the effect in IGR and early type2diabetes.Objective:1. Measure GI value and nutritional value of the replacement diets (the mixture of soybeans, oats, flax seed).2. Observe the influence of blood sugar with low GI diet in diabetes subjects after breakfast and to assess the safety and tolerability.3. Study IGR and early type2diabetic subjects in the communities the glucolipid metabolism, weight control, dietary nutrition intake with low GI diet replacement primarily dietary nutrition intervention mode, which provide prevention and control theoretical basis for the abnormal blood sugar subject in the communities.Methods:1. The common international GI measurement method,50g glucose for reference, determination of edible alternative meal at7after blood glucose value, using Wolever method to calculate the postprandial blood sugar the area under the concentration-time curve (AUC) and alternative prandial GI value, and relative hygiene testing and calculation nutritional value. Recruit10diabetes subjects, observe the change of blood glucose after replacement meal and traditional diet (bread or rice) with the same energy (200kcal). 2. IGR and early type2DM were randomly divided into the intervention group and the control group. Control group to conventional diabetes knowledge propaganda and education; The intervention component two phases, the first phase intervention for3months, low GI diet alternative+diabetes education+blood sugar monitoring+weekly close follow-up; The second phase intervention for9months, monthly follow-up+blood sugar monitoring. Test subjects glycolipids index, waist hip circumference, weight, dietary nutrition intake, physical movement situation, to assess clinical effect.Results:1. GI value of the replacement meal is42.13, with energy447.2kcal per100g, which contain protein21.8g and15.2g of fat and carbohydrate55.8g.2.10diabetes patients intake replacement meal, white steamed bread, rice meal with same calorie (200kcal), the average blood glucose were6.45mmol/L,8.96mmol/L and9.47mmol/L, after two hours, P<0.01.3. Low GI diet alternative primarily dietary nutrition intervention to improve the effects of IGR subjects shows that:in the intervention group, weight (2.2%and2.6%), BMI (2.1%and2.5%), waist circumference (4.1%and4.2%), waist hip ratio (1.0%and2.6%), body fat (6.3%and5.7%), visceral fat area (5.3%and3.3%) and postpranddial blood sugar (10.6%and13.7%) drop in the middle and eventually period; DBP (4.8%), HbA1c (2.1%), TG (16.0%), LDL-C (14.2%) drop and Hdl-C (25.7%) rises only in the eventually period; Dietary fiber rises in the middle and eventually period by26.4%and18.0%respectively; In the Control group:TG drops in the eventually period; Above index change (P<0.05). Physical activity although have increased, but the difference was not statistically significant. IGR intervention group after12months,61.9%of subjects to normal blood sugar level,14.3%into type2DM, control group were36.4%and27.3%respectively, P>0.05.4. Low GI diet alternative primarily dietary nutrition intervention to improve community early type2DM subjects influence shows that:in the intervention group, weight (5.5%and1.5%), BMI (2.1%and1.4%), waist circumference (3.9%and2.2%), waist hip ratio (2.0%and1.7%), body fat (6.5%and4.0%), DBP (5.0%and4.7%) and postpranddial blood sugar (21.9%and15.1%) drop in the middle and eventually period; According to the baseline HbAlc grouping,>6.5%group, eventually period were down by5.0%and4.8%, and<6.5%group were up by1.2%and0.5%respectively. Medium-term decline indicators include visceral fat area (6.0%), SBP (4.5%), fasting plasma glucose (7.8%), C peptide (25.8%), dietary nutrients in carbohydrates, dietary fiber intake increases, and the former is13.6%and8.2%respectively in the middle and eventually period eventually period, and the latter is26.4%and18.0%, in the middle of the fat intake reduced by14.0%;The control group:Soft Lean Mass, Fat Free Mass, visceral fat area, postpranddial blood glucose, insulin, cholesterol and LDL-C are down, P<0.05. Physical activity although has increased, but the difference is not statistically significant. Type2DM intervention group blood sugar (fasting and postprandial), HbAlc, blood pressure and BMI, Hdl-C, TG control success rate rise and LDL-C descends, blood glucose, BMI performance obvious in the medium-term; Control group blood sugar, blood pressure and BMI, LDL-C, TG shows ascendant trend, HbAlc, Hdl-C tended to decline trend, two groups of control terminal phase comparison, HbAlc difference have statistical significance. In addition to LDL-C, intervention group control success rate rising amplitude is greater than the control group.Conclusion:1. With soybean, oats, flax seed into replacement meal is a kind of low GI diet riching in dietary fiber and the nutrition, replacing breakfast can reduce the type2diabetes postprandial blood sugar effectively.2. Low GI diet alternative primarily dietary nutrition intervention can improve IGR subjects postprandial blood sugar, reduce the weight, waist circumference, body fat, visceral fat area, adjusting blood fat, improve outcome, delay the occurrence of type2diabetes.3. Low GI diet alternative primarily dietary nutrition intervention can improve early type2DM subjects postprandial blood sugar, reduce the high glycated hemoglobin patients glycated hemoglobin, reduce weight, waist circumference, body fat and diastolic blood pressure, which is beneficial to early type2DM subjects blood sugar, blood fat, blood pressure, body mass index control success rate.(4) Low GI diet alternative primarily dietary nutrition intervention and education improve IGR and early type2DM dietary structure, which can be used as an effective nutrition intervention in IGR and early type2diabetes control, and should be insisted on. |
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