積極的營養教育介入肥胖之第2型糖尿病人的影響

大部分的第2型糖尿病人本身是肥胖的，或因藥物治療而導致體重逐漸增加。減重可改善肥胖之第2型糖尿病人對血糖、血脂及血壓之控制，並減少或維持其口服降血糖藥物用量。本研究以肥胖的第2型糖尿病人經12週的營養教育介入與熱量限制（有一套標準的飲食衛教教案及流程，並請病人填寫飲食記錄及限制熱量每天1600大卡），比較營養教育前後其體重、腰圍、糖化血色素、血脂、血壓、藥物用量的變化。並比較一年後，其體重復胖程度，糖化血色素、血脂、血壓及藥物用量。以及比較同為糖尿病共同照護計劃的肥胖之第2型糖尿病人無參加此課程的差異。初期參與本研究個案共有37位，中途有7位退出（男性2位，女性5位），最後之完成收案數有30位（男性10位，女性20 位），經12週的積極營養教育介入後，體重、身體質量指數、腰圍、糖化血色素、收縮壓、舒張壓，均有顯著降低。有6人（佔實際收案數的20%）減少口服降血糖藥之用量。本研究介入後一年之追蹤發現，受試者體重與身體質量指數皆顯著低於介入前，但腰圍、糖化血色素、收縮壓、舒張壓、血三酸甘油酯、低密度膽固醇無顯著性差異。此外，本研究之營養教育結束一年後，體重、身體質量指數、腰圍、糖化血色素、收縮壓、舒張壓、血三酸甘油酯、低密度膽固醇與12週的營養教育介入後比較雖皆些許增加，但未達顯著性差異。而與未參加此課程的糖尿病共同照護計劃病人比較，營養教育介入後體重減少及糖化血色素有改善，且口服降血糖藥物減量者的人數較多。因此肥胖的糖尿病人參加密集性的12週營養教育介入後，對其體位改變、血糖及口服降血糖藥物用量皆具有益處。

Most type 2 diabetic patients are obese originally or due to the side effect of some anti-diabetic agents. Weight reduction of obese type 2 diabetic patients may improve the control of blood sugar, lipid profiles and blood pressure. Moreover, this may reduce or maintain the consumption of oral anti-diabetic agents.. This study was aimed at type 2 diabetic patients with obesity who were collected from OPD. The patients received active dietary education for continuous 12 weeks .The dietary education included teaching plan and recording dietary intake and limit caloric intake with 1600 kcal per day.Thirty seven subjects were included in this study, but seven patients dropped out in the duration. There were final thirty subjects (10 men and 20 women) completely finished this program.Results showed that body weight, body mass index, waist circumference, hemoglobin A1C, SBP and DBP were significantly reduced after 12 wks of active dietary education. Six subjects lowered the consumption of oral anti-diabetic agents.After one year of this interventional program, body weight was still lower than before this program, but other parameters showed no difference. All parameters did not show difference when comparing with the end of interventional program. This study clearly elevated that type 2 diabetic obese patients accepted 12 wks of continuous interventive nutritional education could be beneficial to the control of anthropometry, blood sugar and blood pressure