Effect Of Different Medical Nutrition Therapy On Blood Glucose Fluctuation And Insulin Resistance In Elderly Type 2 Diabetes Mellitus Patients

The number of elderly type 2 diabetes mellitus patients is rising year by year with the ageing of population. At present, the management of the elderly diabetes mellitus patients tends to be diversified. In elderly type 2 diabetes mellitus patients,the efficacy of single drug treatment is not satisfactory because of the patient’s blood glucose level is more difficult to be controled stability and glucose variability is fluctuated. Combined with diabetic diet recipe treatment is still have glucose variability, Because the elderly dietary compliance and self-discipline is poor, it is difficult to strictly enforce the long-term diabetes diet recipe in elderly type 2 diabetes mellitus patients. In addition, insulin sensitivity was decreased in majority of elderly type 2 diabetes patients, and insulin resistance is easily lead to glucose and lipid metabolism disorders. Therefore, the management of elderly diabetes patients is not only the management of blood glucose levels, but more important the glucose variability and insulin resistance. To elderly diabetes, it should be needed a measure,which is safe,simple and easy to execute,to control blood glucose level, improve glucose variability and insulin resistance. This research study the effect of different medical nutrition therapy combined with diabetes diet guidance and oral hypoglycemic agents, on blood glucose level, glucose variability and insulin resistance in the elderly type 2 diabetes mellitus patients.ObjectiveTo find a therapy on blood glucose, blood glucose variability and insulin resistance in elderly patients with type 2 diabetes, which is effective, safe and easy to execute.MethodsNinety volunteers with diabetic mellitus were recruited from Department of geriatrics and Department of endocrinology in Kunming Yanan Hospital. All patients were randomly divided into three groups, 30 cases in the control group, 30 cases in the low GI diet group, 30 cases in water- soluble dietary fiber group. Each patient was established a individuality diabetic diet guidance according to the guidelines of medical nutrition therapy, combined with oral hypoglycemic agents. The breakfast and dinner for patients in low GI diet group were completely instead of low GI diet, while the breakfast and dinner for patients in water-soluble dietary fiber group were added 10 g dietary fiber. Blood glucose, blood lipid, renal function,blood glucose fluctuation and insulin resistance were observed before and after one-month intervention. During the one-month intervention, there were 1, 3 and 1 person quit respectively in three groups. Before intervention, all patients were carried out 24-hour recalls for dietary survey, in order to understand the dietary situation.Results1. Compared with before intervention, the concentration of blood glucose in each group was decreased(P<0.05).2. After the intervention,average fasting blood glucose, postprandial glucose average, and mean blood glucose in low GI diet group were significantly lower than those in control group(P<0.05), Meanwhile, the blood sugar standard deviation and MAGE in low GI dietary intervention group and in water-soluble dietary fiber group were significantly lower than that of control group(P<0.05).3. After the intervention,the FINS and HOMA-IR in low GI dietary group and in water-soluble dietary fiber group were significantly decreased than that of control group(P<0.05).4. Compared with before intervention,the concentration of TG in the control group, low GI dietary group and water-soluble dietary fiber group was decreased after the intervention(P<0.05).The level of TC, LDL-C, TG, HDL-C,and TG,in the low GI dietary group was significantly lower than that in the control group and water-soluble dietary fiber group(P<0.05).5. Berore intervention,the dietary survey showed that fat intake was higher, the average fat for energy ratio was over 35%, while the carbohydrate intake was relatively low, many patients with less than 50% of the carbohydrate energy supply, dietary fiber intake was significantly lower.ConclusionOn the basis of the diabetes diet guidance and oral drug treatment giving low GI dietary replacement therapy or adding water soluble dietary fiber, for elderly patients with type 2 diabetes, could effectively control the blood glucose level, significantly reduce glucose variability,and improve insulin resistance.