The Study On Medical Nutrition Intervention Of Pre-diabetic Patients

Objective:Through the Medical nutrition intervention on pre-diabetic patients, to improve their glucose and lipid metabolism, adjust the structure of the gut microbiota, and reduce or delay the occurrence and development of diabetes and other chronic metabolic diseases.To explore a propagable medical nutrition intervention model of pre-diabetes, and push the pre-diabetic patients to take the initiative to intervene the disease.Methods:100 pre-diabetic patients which meet the diagnostic criteria of pre-diabetes were selected from the community,and randomly divided into intervention group(50 cases)and control group(50 cases). The intervention group was given medical nutrition intervention for 9 months(3 stages): The first stage(the first month to the third month),the intervention group was given nutritional education, exercise intervention, dietary intervention, psychological intervention and other medical nutrition intervention through many ways. The second stage(the forth month to the sixth month), on the basis of carrying on the first stage’s intervention, we provided dietary fiber(10g/d) and low GI coarse grains nutritional formula(50g/d) to the intervention group. The third stage(the seventh month to the ninth month), we stopped providing nutritional formula to the intervention group, but continue to intervene in them with nutritional education, exercise and psychological intervention like the first stage. The control group was taken no measures. The intervention group was detected observation indexes before and after the each stage. The control group was detected observation indexes before and after thewhole experiment. The observation indexes includes physical indexes(weight, waist circumference(WC) and so on), blood biochemical indexes(blood sugar, blood fat,fasting insulin(FINS), HOMA Insulin Resistance(HOMA-IR) and so on), gut microbiota indexes(escherichia coli, bifidobacterium and so on). To analyze and compare the test results, and process the data.Results:1. After the whole intervention experiment, the intervention group’s observation indexes, expect systolic blood pressure(SBP), were improved obviously compared with the base line(P<0.05). The control group’s weight increased obviously compared with the base line(P < 0.05), and other change of observation indexes had no statistical significance( P > 0.05). The intervention group’s weight, SBP, diastolic blood pressure(DBP), fasting plasma glucose(FPG), 2-hour postprandial plasma glucose(2h PG),triglyeride(TG), hemoglobin A1C(Hb A1c),FINS and HOMA-IR declined obviously, and bifidobacterium increased obviously, compared with the control group(P<0.05).2. After the first stage, the intervention group’s weight, WC, 2h PG declined obviously compared with the base line(P<0.05), and most of the rest indexes had a trend of improvement, but the difference had no statistical significance(P>0.05).3. After the second stage, the intervention group’s weight, WC, DBP, FPG, 2h PG,TC, TG, LDL-C,Hb A1 c,FINS,HOMA-IR and escherichia coli declined obviously compared with the start of the second stage(P<0.05), and lactobacillus, bifidobacterium increased obviously(P <0.05), HDL-C and SBP had improved, but had no statistical significance(P>0.05).4. After the third stage, the intervention group’s bifidobacterium declined obviously compared with the start of the third stage(P < 0.05), the rest indexes’ change had no statistical significance(P>0.05). The intervention group’s weight, WC, DBP, FPG,2h PG, TC, TG, LDL-C, Hb A1 c 、 FINS 、 HOMA-IR and escherichia coli declined obviously(P<0.05) and lactobacillus, bifidobacterium increased obviously(P<0.05)compared with the end of the first stage.5. After the whole intervention experiment, there are 29 intervention group’s patients’ glucose level return to normal,and the rate is 63%. There are one intervention group’s pre-diabetic patient became diabetic, and the rate is 2.2%. At the same time, there are 5 control group’s patients’ glucose level return to normal,and the rate is 10.6%.There are 6 control group’s patient became diabetic, and the rate is 12.8%. The difference between the two groups’ rate had statistical significance(P<0.05).Conclusions:1. The medical nutrition intervention can improve the pre-diabetic patients’ glucose and lipid metabolism, relieve insulin resistance, and reduce weight, waist circumference,blood pressure, delay or avoid the pre-diabetes round into the diabetes.2. The medical nutrition intervention can adjust the structure of the gut microbiota of pre-diabetic patients, support the beneficial intestinal bacteria, suppress opportunistic pathogen, restore the intestinal microecology, prevent or delay the occurrence and development of diabetes and other Chronic metabolic diseases.3. Dietary fiber and low GI coarse grains nutritional formula can improve the glucose and lipid metabolism, the structure of the gut microbiota of pre-diabetic patients.