妊娠期糖尿病高危女性孕早期生活方式干预改善血糖和胰岛素敏感性

在二型糖尿病个体中进行健康饮食和物理运动等生活方式干预可以有效改善其胰岛素敏感性。但这一效益是否能在妊娠性糖尿病高危女性(GDM)中观察到还不清楚。为了证明生活方式干预可以减少GDM高危人群中作用我们进行了一项必要的试验，这项试验针对孕期超重/肥胖低收入黑人的女性，这些女性在大城市医院进行产前检查。这些女性随机分为进行生活方式干预组（LSI n=28）--每月进行访视，旨在在增加水果和蔬菜的摄入，减少脂肪和糖的摄入水平，并且进行适度活动—或者常规检查组(RC n=29)。我们利用75g OGTT试验来在试验的开始 (V1 孕期(GA): 14.4±2.9 周)血糖测试并在孕中期(V4 GA: 26.5±2.5 周)进行禁食后测试（0 30 60 90 120）分钟来计算mean±SD曲线下的血糖面积。我们同时测算了禁食和30分钟后的中位（区间）胰岛素水平并计算其胰岛素抵抗指数。在V1时，两组的gAUCRC: 12990.5±1718.2 vs. LSI: 12285.1±2340)，禁食和30分钟胰岛素水平类似(30 min: 88.8 [41.4 274.8] vs. 98.0 [21.6 268.7])。在常规组中，在V1到V4之间其gAUC和30分钟胰岛素同时显著增加(p≤0.05)，但生活方式干预组没有出现这一情况。在V4时，相比于生活方式干预组，常规组的平均30分钟血糖更高(125.7±22.5 vs. 111.6±15.7 mg/dL p=0.05)并且中位30分钟胰岛素水平也更高(103.0 [39.4 327.6] vs. 85.8 [37.5 200.8] uU/mL p<0.05)。我们接下来在V4时观察到RC组相比于LSI组的胰岛素水平非显著性提高的趋势(中位 胰岛素抵抗指数: 2.7 [0.6 31.2]; LSI: 2.2 [0.7 8.3]。与V1期的平均差异分别是1.36 vs 0.16。这些结果显示：对孕早期高危人群的生活方式干预实施，可能改善了其孕期产生的胰岛素耐受的血糖反应。

Lifestyle interventions (LSI) promoting healthy diets and physical activity are effective in improving insulin sensitivity among individuals with type 2 diabetes. Whether the same effect is observed among women at high risk for gestational diabetes mellitus (GDM) is unclear. To inform interventions to reduce GDM amongst high-risk groups we conducted a feasibility trial among pregnant overweight/obese low-income Black women receiving prenatal care at a large metropolitan hospital. Women were randomly assigned to receive lifestyle intervention (LSI n=28) -- monthly visits (V) focused on increasing fruit and vegetable intake reducing intakes of fat and sugars and increasing levels of moderate physical activity -- or regular care (RC n=29). Using a 75g OGTT we measured glucose at study entry (V1 gestational age (GA): 14.4±2.9 wk) and mid-pregnancy (V4 GA: 26.5±2.5 wk) with measures taken at 0 (fasting) 30 60 90 and 120 min and calculated mean±SD glucose area under the curve (gAUC). We also measured median (range) insulin at fasting and 30 min and calculated HOMA-IR. At V1 the groups were similar for gAUC (RC: 12990.5±1718.2 vs. LSI: 12285.1±2340) and fasting and 30 min insulin (30 min: 88.8 [41.4 274.8] vs. 98.0 [21.6 268.7]). gAUC and 30 min insulin both increased significantly from V1 to V4 in the RC (p≤0.05) but not LSI group. At V4 when compared with the LSI group the RC group had higher mean 30 min glucose (125.7±22.5 vs. 111.6±15.7 mg/dL p=0.05) and median 30 min insulin levels (103.0 [39.4 327.6] vs. 85.8 [37.5 200.8] uU/mL p<0.05). We subsequently observed a non-significant trend toward improved insulin sensitivity in the LSI group vs. RC group at V4 (median HOMA-IR RC: 2.7 [0.6 31.2]; LSI: 2.2 [0.7 8.3]; mean difference from V1: 1.36 vs 0.16 respectively). These results suggest that a lifestyle intervention implemented early in pregnancy in this high-risk population may improve glucose response to pregnancy-induced insulin resistance.

编辑： 黄石    来源：丁香园