摘要
目的系统评价生酮饮食对2型糖尿病(T2DM)患者血糖控制、体质量管理和脂代谢相关指标的干预效果。方法本研究使用Pubmed、Embase、Cochrane library、CNKI数据库,检索有关生酮饮食治疗T2DM的随机对照试验。设立纳入与排除标准,按照Cochrane偏倚风险评判标准对文献进行质量评价,采用Rev Man5.3软件进行Meta分析,并对异质性较大的试验结果进行干预时间的亚组分析。结果共纳入9篇文献,包括695例T2DM患者。①与对照饮食相比,生酮饮食显著降低了T2DM患者的空腹血糖(MD=-0.22,95%CI为-0.29^-0.15,P<0.001)、空腹胰岛素水平(MD=-1.23,95%CI为-1.89^-0.57,P=0.003)和胰岛素抵抗指数(MD=-0.10,95%CI为-0.20^-0.01,P=0.03)。②亚组分析结果表明,当干预时间≤6个月,生酮饮食显著降低了T2DM患者的糖化血红蛋白(MD=-0.41,95%CI为-0.46^-0.35,P<0.001)、体质量(MD=-2.46,9%CI为-3.98^-0.94,P=0.002)和体质量指数(MD=-3.07,95%CI为-3.77^-2.37,P<0.001);当干预时间>6个月,2组无显著差异(P>0.05)。③超过6个月的生酮饮食能显著降低T2DM患者的甘油三酯(MD=-0.36,95%CI为-0.49^-0.22,P<0.001),升高高密度脂蛋白胆固醇(MD=0.09,95%CI为0.02~0.17,P=0.02),但降低总胆固醇(MD=0.11,95%CI为0.01~0.20,P=0.03)和低密度脂蛋白胆固醇(MD=0.14,95%CI为0.03~0.24,P=0.01)水平不如对照饮食。结论短期的生酮饮食可明显改善T2DM患者的血糖代谢,降低体质量和体质量指数,但长期效果不明显。长期的生酮饮食可降低甘油三酯,升高高密度脂蛋白胆固醇,但对降低总胆固醇和低密度脂蛋白胆固醇无明显作用。生酮饮食干预2型糖尿病临床实践的学术价值在于:打破了长期以来国内外学术界关于"糖尿病是一种慢性进行性疾病,需长期进行药物或胰岛素治疗"的思维定势,全新的生活方式干预可能是防治糖尿病的根本之道。
Objective To systematically evaluate the effect of ketogenic diet on blood glucose control,weight management and lipid metabolism indexes in patients with type 2 diabetes mellitus (T2DM). Methods In this study,the databases such as PubMed,EMBASE,Cochrane Library and CNKI were used to search for randomized controlled trials of ketogenic diet in the treatment of T2DM.We set the inclusion and exclusion criteria and the quality of the literature was evaluated according to the assessment criteria of Cochrane bias risk. We used RevMan5. 3 for the Meta-analysis,and the subgroup analysis of intervention time was carried out for the results with higher heterogeneity. Results A total of 9 studies with 695 T2DM patients were included. ① Compared with the controlled diets,ketogenic diet led to greater reductions in fasting plasma glucose (MD =-0. 22,95% CI was-0. 29 to-0. 15,P < 0. 001),fasting insulin (MD =-1. 23,95% CI was-1. 89 to-0. 57,P = 0. 003)and insulin resistance index (MD =-0. 10,95% CI was-0. 20 to 0. 01,P = 0. 03) . ② The results of subgroup analysis showed that ketogenic diet significantly decreased glycosylated hemoglobin (MD =-0. 41,95% CI was-0. 46 to-0. 35,P <0. 001),body weight (MD =-2.46,95%CI was-3. 98 to-0. 94,P = 0. 002) and body mass index (MD =-3. 07,95% CI was-3. 77 to-2. 37,P < 0. 001) when the intervention time was less than or equal to 6 months. There was no significant difference in the indexes mentioned above between the two groups when the intervention time was more than 6 months (P > 0. 05) . ③ Ketogenic diet for more than 6 months effectively reduced triglyceride (MD =-0. 36,95% CI was-0. 49 to-0. 22,P < 0. 001) and increased high density lipoprotein cholesterol (MD = 0. 09,95% CI was 0. 02 to 0. 17,P = 0. 02),but it was not as good as control diet in reducing total cholesterol (MD = 0. 11,95% CI was 0. 01 to 0. 20,P =0. 03) and low density lipoprotein cholesterol (MD = 0. 14,95% CI was 0. 03 to 0. 24,P = 0. 01).Conclusion Short-term ketogenic diet can significantly improve glucose metabolism and reduce body weight and body mass index in T2DM patients,but its long-term effect is not obvious. Longterm ketogenic diet can reduce triglyceride and increase high density lipoprotein cholesterol,but shows no effects on total cholesterol and low density lipoprotein cholesterol. For a long period of time,a stereotype is rooted in people’s mind that diabetes is a chronic progressive disease requiring long-term drug or insulin treatment in domestic and foreign academic circles. The greatest academic value of ketogenic diet intervention is that it breaks through the stereotype,and makes it possible to treat and prevent diabetes by a new lifestyle intervention.
作者
赵岩
李力
董贤慧
王菊阳
ZHAO Yan;LI Li;DONG Xianhui;WANG Juyang(The First Clinical College of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,450000;Hangzhou Normal University,Hangzhou,Zhejiang,321004;The Affiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang,310000;The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou,Henan,450000)
出处
《实用临床医药杂志》
CAS
2020年第18期87-97,共11页
Journal of Clinical Medicine in Practice
基金
杭州师范大学科研启动基金(2018QDL038)。
