調整進餐速度對第2型糖尿病人血糖控制之成效

Effect of Adjusting Eating Speed on Glycemic Control in Type 2 Diabetes

黃佳進(Jia-Jin Huang) ； 林欣儀(Xin-Yi Lin) ； 黃秋玲(Chiou-Ling Huang) ； 簡誌銘(Chih-Ming Chien) ； 戴研光(Yen-Kuang Tai)

《臺灣膳食營養學雜誌》 11卷1期 (2019/06) Pp. 1-15

https://doi.org/10.6709/TJD.201906_11(1).0001

摘要

臨床發現第2型糖尿病人血糖控制不佳通常與肥胖或飲食習慣不佳有關，包括進餐速度。研究指出放慢進餐速度具有改善體重、血糖及血脂等功效，然而較少研究分析第2型糖尿病人進餐速度快慢與血糖調控之影響。因此本研究以第2型糖尿病人身體質量指數≥ 24 kg/m^2及自述進餐速度快（＜ 15分鐘／餐）為研究對象，分析不同進餐速度與血糖控制之成效。符合收案標準者共有32位，分別利用交叉試驗及隨機試驗來觀察短期及長期之效應。交叉試驗分析受試者（n = 13）在不同進餐速度（＜ 15及≥ 30分鐘／餐）下，餐前及餐後30、60、120分鐘之血漿葡萄糖與血清胰島素濃度變化。隨機試驗分成快速進食組（＜ 15分鐘／餐）及緩慢進食組（≥ 30分鐘／餐），分析不同時間點0、3、6個月之體位、糖化血色素（glycated hemoglobin, HbA1c, %）、血壓、血脂及飲食攝取量變化。結果顯示，交叉試驗之進餐速度≥ 30分鐘／餐相較於＜ 15分鐘／餐，其血漿葡萄糖與血清胰島素濃度皆於飯後30及60分鐘有顯著降低。隨機試驗兩組組內之高密度脂蛋白膽固醇（high density lipoprotein cholesterol, HDL-C）及HbA1c於第6個月皆有顯著改善（p ＜ 0.05），尤以緩慢進食組組內改善程度較大（緩慢進食組：5.5 ± 4.8 mg/dL及-0.6± 0.3%，快速進食組：2.7 ± 4.8 mg/dL及-0.4 ± 0.3%）。兩組間三大營養素攝取量以緩慢進食組之碳水化合物有顯著減少。營養師每月利用飲食校正積分表確認受試者整體遵從度，該積分表滿分為10分，當個人整體遵從度平均積分≥ 9分時，發現緩慢進食組亦比快速進食組更具改善HbA1c趨勢（-0.8 ± 0.6%, p = 0.268 vs. -0.4 ± 0.8%, p = 0.355）。綜合上述可知，放慢進餐速度可能有助於第2型糖尿病人短期飯後血糖及胰島素控制，以及長期HDL-C及HbA1c改善之趨勢。然而，未來仍需更多樣本數來確定放慢進餐速度為第2型糖尿病人帶來臨床利益。

關鍵字

第2型糖尿病 ； 進餐速度 ； 血清胰島素 ； 糖化血色素 ； 血漿葡萄糖

並列摘要

According to clinical observation, unsatisfactory control of blood sugar in patients with type 2 diabetes is often associated with obesity or poor eating habits, including overly fast eating speed. Research has reported that slow eating speed is effective in reducing weight, blood sugar, and blood lipid. However, few studies have analyzed the effect of eating speed on blood sugar control in patients with type 2 diabetes. Therefore, this study targeted patients with type 2 diabetes whose body mass index was ≥ 24 kg/m^2 and self-reported eating speed was ＜ 15 min per meal, analyzing the effect of eating speed on blood sugar control. A total of 32 patients met the recruitment criteria. Crossover and randomized trials were conducted to observe the short-term and long-term effect. In the crossover trial, blood glucose and serum insulin of participants (n = 13) before meal and 30, 60, and 120 min after meal were measured under eating speed of ＜ 15 and ≥ 30 min. For the randomized trial, participants were divided into fast eating (＜ 15 min) and slow eating (≥ 30 min) groups, and their weight, glycated hemoglobin (HbA1c) level, blood pressure, blood lipid level, and dietary intake at the baseline and after 3 and 6 months were measured. The crossover trial results showed that compared with the participants with eating speed of ＜ 15 min, the participants with eating speed of ≥ 30 min exhibited significantly decreased blood glucose and serum insulin levels 30 and 60 min after meal. In the randomized trial, both the two groups showed significantly improved levels of high density lipoprotein cholesterol (HDL-C) and HbA1c at the sixth month (p ＜ 0.05). In particular, the slow eating group (5.5 ± 4.8 mg/dL and -0.6 ± 0.3%) had larger extent of improvement than the fast eating group (2.7 ± 4.8 mg/dL and -0.4 ± 0.3%). Regarding the calorie, carbohydrate, and protein intakes, the slow eating group showed significantly reduced carbohydrate intake. The dietitian used the diet correction scoring sheet (with a total score of 10 points) to confirm the participants' overall compliance every month. When the overall compliance of individual participants was ≥ 9 points, the slow eating group exhibited higher improvement in their HbA1c levels than those of the fast eating group (-0.8 ± 0.6%, p = 0.268 vs. -0.4 ± 0.8%, p = 0.355). Accordingly, slow eating speed is conducive to short-term post meal blood sugar and insulin control and long-term HDL-C and HbA1c control in patients with type 2 diabetes. However, more samples are required in future studies to confirm the clinical benefits of slow eating speed in patients with type 2 diabetes.

並列關鍵字

type 2 diabetes ； eating speed ； serum insulin ； glycated hemoglobin ； blood glucose