| BackgroundAs the basictherapeutic measureof all types of diabetes, nutrition intervention is essential for the prevention and controlin any phase of the natural course.Diet intervention can stable blood sugar,adjustweight,and to some extent, promote the pancreatic hormone secretion.So as to reduce or delay the onset and development of various complications,ultimately improve the quality of life.At present, the most commonly food diet intervention measures arefood exchange method and glycemic index and glycemie load method.Food exchange method can restrict the energy consumption and keepthe amount of carbohydrate of each exchangeconstantly, but cannot distinguishthepostprandial blood glucose responseof the same exchange and the effect of cooking methods and mature degree on the blood sugar. Glycemic index reflects the absorption rate of carbohydrates and the extent of effect on blood sugar, but cannot reflect the glucose reaction of actual intakeand blod sugar index value is influenced by many factors.Glycemic load, which combine the quality and quantity of carbohydrates, to evaluate the overall effect of blood sugar, can make up the glycemic index, to reflect the effect of glycemic response more truly and intuitively.Postprandial blood glucose is considered to be an independent risk factor for cardiovascular adverse outcomes. The large fluctuations of postprandial blood glucose is related to the complications of capillaries and large vascular.The change about the peak of the postprandial blood glucose and blood sugar and the correlation of the incidence of atherosclerosis are more significant than fasting blood sugar and glycated haemoglobin.Therefore, safe and effective dietary interventions need to focus on reducing the fluctuation of postprandial blood glucose. Study shows, the control of postprandial blood glucose can be better through the "vegetable first" model.Our research is armd at surveying the dietary nutrition status of T2DM patients in community, then apply the "GI combination of GL food exchange" model to diet education for a period of12months intervention and evaluate its effect.In order to seek a effective and simple diet education intervention method.At the same time, vertify the controlling effectiveness of "vegetable first" feeding order on the postprandial blood glucose which to rich the diet intervention method of chronic diseases.Objectives1. Realize the master degree about the diet knowledge and dietary status of T2DM patients in community;2. Discuss the effect of the "GI combination of GL based on the food exchange method" for T2DM patients about diet composition, blood glucose, blood lipids and the human body measurements;3. Vertify the validity of "vegetable first" model to the control of the postprandial blood glucose.Methods1. Use the general data questionnaire, diabetes diet education situation questionnaire, and the food frequency questionnaire and body measurements to survey the dietary education situation and dietary status of T2DM patients in community, analysis and evaluation of dietary total energy intake and the distribution of the three major nutrients.2.Divided80cases of T2DM patients into intervention group and control group randomly,40cases in each one.Intervention group use the GI combination of GL based on the food exchange method and the control group with traditional food exchange method.Intervention lasts12months,carry on the comprehensive evaIuation.Evaluate the diety knowledge score, average daily dietary components and total GI, GL value,the fasting blood glucose,2h postprandial blood glucose, glycosylated hemoglobin, blood fipid and weight, waist circumference, blood pressure at timestamp of before the intervention,3months,6months and12months after the intervention. Analyse the effect of the dietary composition and blood sugar, blood lipids with the "GI combination of GL food exchange " method.3.12cases of T2DM patients, eating breakfast according to two different orders: one is based on their own daily habits (that isthe mixed order); another is the "vegetable first". Extract fasting and postprandial samples of30,60,120minutes respectively, test the blood sugar and insulin values. Analyse the effect of the "vegetable first" model to the postprandial blood glucose control.Results1.233cases in250patients get dietary education through various channels, but they are not reached in understanding and using information.The dietary structure was unreasonable which show that the daily total calorie intake is higher than the average daily standard, and the distribution proportion of three major nutrients was unreasonable:carbohydrate intake was insufficient (35.6%), intake of fat and protein (48.4%,78%) was over the guidelines recommend.2.Afler the intervention, diabetes diet knowledge score, GI and GL scoreof intervention groupwere significantly higher than the control group (P<0.05). The total calorie of two groupswasreduced than before, and the distributionof three major nutrients wasmore improved thanbefore. Average daily dietary GI, GL value lower than the control group significantly in intervention group (P<0.05). 3.Affer the intervention,2h postprandial blood glucose, fasting glucose, gfycosylated hemoglobin of intervention groupwere lower than before (P<0.05), and superior to the controlgroup.Interventiongroup and control group in total cholesterol, low density lipoprotein cholesterol levels were lower than before the intervention (P<0.05).4. After the intervention, weight and waistline about intervention group were reducedcompared with before (P<0.05).5. In30,60minutes after meal,"vegetable first" method compared with the mixed feeding can reduce postprandial blood glucose fluctuations, and insulin demand (P<0.05).Conclusions1. The main education method is food exchange method, the popularization and awareness rate of glycemic index and glycemic toad is small and few appling in the daily diet.2. Total daily calories intake and allocation of three major nutrients is unreasonable, carbohydrate intake was deficiencies, protein and fat intake wasbeyond the guidelines recommended.3.GI combination of GL food exchange method is better than traditional food exchange portion which can effectively reduced the fasting blood glucose,2h postprandial blood glucose, glyycosylated hemoglobin, and body mass index, and long-term effectively.4. The "vegetable first" method can reduce postprandial blood sugar fluctuation, and increase satiety, restrict too much energy intake. The "vegetable first" method can rich the diet intervention of chronic diseases. |
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