Diabetologia：糖尿病患者的冠军早餐

  现代社会肥胖的流行引发了糖尿病发生率的惊人上升，目前全球有超过3.82亿的个体都患有糖尿病，主要为2型糖尿病，对于这些患者而言，血糖水平激增对其往往是致命性的，会引发其患心血管疾病的并发症。近日，一篇发表在国际杂志Diabetologia上的研究论文中，来自特拉维夫大学等处的研究人员通过研究提出了一种新型的方式，即通过吃高热量早餐和低热量的晚餐或许可以帮助抑制个体机体中葡萄糖的激增，而这种高热量早餐和低热量晚餐的结合方式或许可以明显降低2型糖尿病患者机体的每日总体血糖水平。

  研究者Jakubowicz说道，当服用高热量早餐时，葡萄糖对食物的反应是最低的，在晚餐时个体需要摄入较低的热量，餐后机体的血糖会上升达到巅峰，而利用这种方式或许可以明显降低全天个体机体的血糖水平。

  文章中，研究者对年龄在30至70岁间患2型糖尿病的8名男性和10名女性进行研究，这些患者被随机进行分配，服用B餐或D餐一周，B餐包括2946千焦热量的早餐，2523千焦的午餐及858千焦的晚餐；而D餐则包括858千焦的早餐、2523千焦的午餐及2946千焦的晚餐，两种饮食方式都包含有相同的总能量；B饮食方式中的早餐餐量较大，包括两片面包、牛奶、鲔鱼、格兰诺拉燕麦卷、炒鸡蛋、酸奶酪及谷类，而餐量较少的却包括意大利干酪、凉拌菜及咖啡等。

  在进行测试前这些糖尿病患者持续6天服用不同类别的餐种，在第7天时每一组的研究对象都在诊所食用提前分配好的三餐，同时在早餐前和餐后收集他们的血样，同时在午餐和晚餐前后也收集参与者的血样；研究者对每一位参与者都进行了餐后血糖的测定，同时也测定了他们机体胰岛素、c肽及高血糖素样肽1的水平；两周后所有的参与者转化三餐的服用方式，同时进行上述检测。研究结果表明，相比D餐而言，进行B餐服用的患者餐后葡萄糖水平上升的幅度下降了20%，而胰岛素、c肽及高血糖素样肽1的水平上升了20%。

  尽管研究中两种餐种所含的能量相同，但个体提前服用大量的早餐后，再进行午餐服用后机体葡萄糖水平的上升幅度会降低23%。研究者指出，高热量的早餐及低热量的晚餐的结合或许可以作为一种有效的方式来帮助降低糖尿病患者的机体血糖的上升，这或许也可以作为一种强大的治疗手段来帮助改善个体的血糖控制，同时也可有效降低2型糖尿病患者患心血管疾病的风险。（转化医学网360zhyx.com）

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转化医学网推荐的原文摘要：

High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial
Diabetologia doi:10.1007/s00125-015-3524-9
Daniela Jakubowicz, Julio Wainstein, Bo Ahrén, Yosefa Bar-Dayan, Zohar Landau, Hadas R. Rabinovitz, Oren Froy
Aims/hypothesis
High-energy breakfast and reduced-energy dinner (Bdiet) significantly reduces postprandial glycaemia in obese non-diabetic individuals. Our objective was to test whether this meal schedule reduces postprandial hyperglycaemia (PPHG) in patients with type 2 diabetes by enhancing incretin and insulin levels when compared with high-energy dinner and reduced-energy breakfast (Ddiet).
Methods
In a randomised, open label, crossover design performed in a clinic setting, 18 individuals (aged 30–70 years with BMI 22–35 kg/m2) with type 2 diabetes (<10 years duration) treated with metformin and/or diet were given either Bdiet or Ddiet for 7 days. Participants were randomised by a person not involved in the study using a coin flip. Postprandial levels of plasma glucose, insulin, C-peptide and intact and total glucagon-like peptide-1 (iGLP-1 and tGLP-1) were assessed. The Bdiet included 2,946 kJ breakfast, 2,523 kJ lunch and 858 kJ dinner. The Ddiet comprised 858 kJ breakfast, 2,523 kJ lunch and 2,946 kJ dinner.
Results
Twenty-two individuals were randomised and 18 analysed. The AUC for glucose (AUCglucose) throughout the day was 20% lower, whereas AUCinsulin, AUCC-peptide and AUCtGLP-1 were 20% higher for the Bdiet than the Ddiet. Glucose AUC0–180min and its peak were both lower by 24%, whereas insulin AUC0–180min was 11% higher after the Bdiet than the Ddiet. This was accompanied by 30% higher tGLP-1 and 16% higher iGLP-1 levels. Despite the diets being isoenergetic, lunch resulted in lower glucose (by 21–25%) and higher insulin (by 23%) with the Bdiet vs Ddiet.
Conclusions/interpretation
High energy intake at breakfast is associated with significant reduction in overall PPHG in diabetic patients over the entire day. This dietary adjustment may have a therapeutic advantage for the achievement of optimal metabolic control and may have the potential for being preventive for cardiovascular and other complications of type 2 diabetes.