糖代謝異常
欧米において糖尿病患者への食事の栄養構成のエビデンスより糖尿病用の経腸栄養剤が開発され本邦においても広く使用されるようになった。この種の製剤の使用により空腹時、食後血糖の改善や内因性インスリン反応の減少、投与インスリンの減少などの報告は数多く、最近は血糖変動の平坦化にも有利だとするものも見られる。その一方で、中～長期にわたる介入による治療成績、入院期間や合併症や続発症への効果及び医療経済的な評価などに関するエビデンスは明らかではない。 現時点においては、個々の症例ごとに基礎疾患の病態に加え耐糖能の程度や血糖変動の状態を踏まえながら忍容性を考慮しつつ、投与内容を決定するのが妥当と言えよう。...
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| Published in | 静脈経腸栄養 Vol. 27; no. 2; pp. 689 - 695 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本静脈経腸栄養学会
2012
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1344-4980 1881-3623 |
| DOI | 10.11244/jjspen.27.689 |
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| Abstract | 欧米において糖尿病患者への食事の栄養構成のエビデンスより糖尿病用の経腸栄養剤が開発され本邦においても広く使用されるようになった。この種の製剤の使用により空腹時、食後血糖の改善や内因性インスリン反応の減少、投与インスリンの減少などの報告は数多く、最近は血糖変動の平坦化にも有利だとするものも見られる。その一方で、中～長期にわたる介入による治療成績、入院期間や合併症や続発症への効果及び医療経済的な評価などに関するエビデンスは明らかではない。 現時点においては、個々の症例ごとに基礎疾患の病態に加え耐糖能の程度や血糖変動の状態を踏まえながら忍容性を考慮しつつ、投与内容を決定するのが妥当と言えよう。 |
|---|---|
| AbstractList | 欧米において糖尿病患者への食事の栄養構成のエビデンスより糖尿病用の経腸栄養剤が開発され本邦においても広く使用されるようになった。この種の製剤の使用により空腹時、食後血糖の改善や内因性インスリン反応の減少、投与インスリンの減少などの報告は数多く、最近は血糖変動の平坦化にも有利だとするものも見られる。その一方で、中～長期にわたる介入による治療成績、入院期間や合併症や続発症への効果及び医療経済的な評価などに関するエビデンスは明らかではない。 現時点においては、個々の症例ごとに基礎疾患の病態に加え耐糖能の程度や血糖変動の状態を踏まえながら忍容性を考慮しつつ、投与内容を決定するのが妥当と言えよう。 |
| Author | 野上, 哲史 |
| Author_FL | NOGAMI Tetsushi |
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| References | 15) Arinzon Z, Shabat S, Shuval I, et al. Prevalence of diabetes mellitus in elderly patients received enteral nutrition longterm care service. Arch Gerontol Geriatr 47: 383-393, 2008. 32) 上原昌哉、谷口佳奈子、碇富美子ほか. インスリン使用2型糖尿病患者に対するインスローの効果. 日本病態栄養学会誌 10 : 281-285、2003. 22) Pohl M, Mayr P, Mertl-Roetzer M, et al. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomized controlled trial. Eur J Clin Nutr 59: 1221-1232, 2005. 12) Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 117: 1018-1027, 2008. 31) 庄司有里、新井英一、水野昭ほか. 新規流動食 (MHN-01) 及び従来流動食 (SBF) の食後血糖値及びインスリン分泌量の比較. 日本病態栄養学会誌 6 : 303-309、2003. 7) Moghissi ES, Korytkoeski MT, Dinardo M. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 32: 1119-1131, 2009. 29) H. Lochsa, S. P. Allisonb, R. Meierc, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics. Clinical Nutrition 25, 180-186, 2006. (available at www.espen.org 35) 桜井洋一、浦めぐみ、大岡百合子ほか. 高一価不飽和脂肪酸経腸栄養剤の糖代謝、脂肪脂質代謝、栄養状態に対する長期的投与効果 外科と代謝・栄養 37 : 33-44、2003. 16) Garg A, et al. Comparison of a high carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 319: 29-834, 1988. 3) Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358: 125-139, 2008. 5) Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized, controlled trials. Arch Intern Med 164: 2005-2011, 2004. 25) 森豊、大田照男、田中孝明ほか. CGMを用いて評価した糖尿病患者の24時間血糖変動に及ぼす低GI (Glycemic Index)・GL (Glycemic Load) 流動食と低GI流動食の比較 静脈経腸栄養 26 : 1125-1131、2011. 6) Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 345: 1359-1367, 2001. 1) Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 300: 933-944, 2008. 4) Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical site infections among cardiothoracic surgery patients. Infec Control Hosp Epidemiol 22: 607-612, 2001. 20) The diabetes and nutrition study group of the European Aassociation for the Study of Diabetes. Recommedations for the nutritional management of patients with diabetes mellitus. Europian Jounal of clinical nutrition 54: 353-355, 2000. 17) Craig LD, et al. Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2 diabetes. Nutrition 14: 529-534, 1998. 30) J Yokoyama, Y Someya, R Yoshihara, et al Effect of high-monounsaturated fatty acid enteral formula on plasma glucose concentration and insulin secretion in healthy individuals and diabetic patients. The journal of international medical research 36: 137-146, 2008. 33) 粟田浩、小嶋由子、藤森林ほか. 脂肪・炭水化物調製栄養食品 (グルセルナ®) の周術期血糖コントロールにおける有用性. 静脈経腸栄養 18 : 45-50、2003. 11) The nice-sugar study investigators Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360: 1283-1297, 2009. 28) ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatricpatients. JPEN J Parenter Enteral Nutr 26 (1 Suppl), 2002. 19) International Diabetes Federation Guideline for management of postmeal glucose. Brussels: International Diabetes Federation; 2006. (available at www.idf.org 27) 日本静脈経腸栄養学会編. 静脈経腸栄養ガイドライン第2版. 南江堂、東京、2006. 26) Louis Monnier, MD; Emilie Mas, PhD; Christine Ginet, MD. Activation of Oxidative Stress by Acute Glucose Fluctuations Compared With Sustained Chronic Hyperglycemia in Patients With Type 2 Diabetes JAMA 295 (14) : 1681-1687, 2006. 10) Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med 35: 2262-2267, 2007. 34) 福島亮治、長谷部正晴、森田直巳ほか. 耐糖能が低下した高齢経管栄養患者におけるL-イソロイシン配合流動食 (DM-1) の血糖値上昇抑制効果 静脈経腸栄養 26 : 757-763、2011. 8) 日本糖尿病学会編. 科学的根拠に基づく糖尿病診療ガイドライン2010. 南江堂、東京、2010. 24) Carolyn J. Alish, W. Timothy Garvey, Kevin C. et al. A Diabetes-Specific Enteral Formula Improves Glycemic Variability in Patients with Type 2 Diabetes Diabetes. Technology & Therapeutics 12 (6): 419-425, 2010. 9) Devos P, Preiser JC, Me´lot C, et al. Impact of tight glucose control by intensive insulin therapy on ICU mortality and the rate of hypoglycaemia: final results of the Glu Control study. Intensive Care Med 33: S189, 2007. 13) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008; 358:2545-2559, 2008. 18) American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care Sup1 26: S51-S61, 2003. 2) Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87: 978-982, 2002. 14) Pancorbo-H PL, García-FFP, Ramírez-P C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs 10: 482-490, 2001. 23) Voss AC, Maki KC, Garvey WT, et al. Effect of two carbohydrate-modified tube-feeding formulas on metabolic responses in patients with type 2 diabetes. Nutrition 24 (10): 990-7, 2008. 21) Elia M, Ceriello A, Laube H, et al. Enteral nutrition support and use of diabetes-specific formulas for patients with diabetes. A systematic review and meta-analysis. Diabetes Care 28: 2267-2279, 2005. |
| References_xml | – reference: 5) Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized, controlled trials. Arch Intern Med 164: 2005-2011, 2004. – reference: 30) J Yokoyama, Y Someya, R Yoshihara, et al Effect of high-monounsaturated fatty acid enteral formula on plasma glucose concentration and insulin secretion in healthy individuals and diabetic patients. The journal of international medical research 36: 137-146, 2008. – reference: 32) 上原昌哉、谷口佳奈子、碇富美子ほか. インスリン使用2型糖尿病患者に対するインスローの効果. 日本病態栄養学会誌 10 : 281-285、2003. – reference: 7) Moghissi ES, Korytkoeski MT, Dinardo M. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 32: 1119-1131, 2009. – reference: 23) Voss AC, Maki KC, Garvey WT, et al. Effect of two carbohydrate-modified tube-feeding formulas on metabolic responses in patients with type 2 diabetes. Nutrition 24 (10): 990-7, 2008. – reference: 33) 粟田浩、小嶋由子、藤森林ほか. 脂肪・炭水化物調製栄養食品 (グルセルナ®) の周術期血糖コントロールにおける有用性. 静脈経腸栄養 18 : 45-50、2003. – reference: 2) Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 87: 978-982, 2002. – reference: 24) Carolyn J. Alish, W. Timothy Garvey, Kevin C. et al. A Diabetes-Specific Enteral Formula Improves Glycemic Variability in Patients with Type 2 Diabetes Diabetes. Technology & Therapeutics 12 (6): 419-425, 2010. – reference: 29) H. Lochsa, S. P. Allisonb, R. Meierc, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics. Clinical Nutrition 25, 180-186, 2006. (available at www.espen.org) – reference: 1) Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA 300: 933-944, 2008. – reference: 34) 福島亮治、長谷部正晴、森田直巳ほか. 耐糖能が低下した高齢経管栄養患者におけるL-イソロイシン配合流動食 (DM-1) の血糖値上昇抑制効果 静脈経腸栄養 26 : 757-763、2011. – reference: 12) Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation 117: 1018-1027, 2008. – reference: 35) 桜井洋一、浦めぐみ、大岡百合子ほか. 高一価不飽和脂肪酸経腸栄養剤の糖代謝、脂肪脂質代謝、栄養状態に対する長期的投与効果 外科と代謝・栄養 37 : 33-44、2003. – reference: 28) ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatricpatients. JPEN J Parenter Enteral Nutr 26 (1 Suppl), 2002. – reference: 17) Craig LD, et al. Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2 diabetes. Nutrition 14: 529-534, 1998. – reference: 11) The nice-sugar study investigators Intensive versus conventional glucose control in critically ill patients. N Engl J Med 360: 1283-1297, 2009. – reference: 6) Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 345: 1359-1367, 2001. – reference: 21) Elia M, Ceriello A, Laube H, et al. Enteral nutrition support and use of diabetes-specific formulas for patients with diabetes. A systematic review and meta-analysis. Diabetes Care 28: 2267-2279, 2005. – reference: 26) Louis Monnier, MD; Emilie Mas, PhD; Christine Ginet, MD. Activation of Oxidative Stress by Acute Glucose Fluctuations Compared With Sustained Chronic Hyperglycemia in Patients With Type 2 Diabetes JAMA 295 (14) : 1681-1687, 2006. – reference: 9) Devos P, Preiser JC, Me´lot C, et al. Impact of tight glucose control by intensive insulin therapy on ICU mortality and the rate of hypoglycaemia: final results of the Glu Control study. Intensive Care Med 33: S189, 2007. – reference: 8) 日本糖尿病学会編. 科学的根拠に基づく糖尿病診療ガイドライン2010. 南江堂、東京、2010. – reference: 10) Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med 35: 2262-2267, 2007. – reference: 3) Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358: 125-139, 2008. – reference: 19) International Diabetes Federation Guideline for management of postmeal glucose. Brussels: International Diabetes Federation; 2006. (available at www.idf.org) – reference: 31) 庄司有里、新井英一、水野昭ほか. 新規流動食 (MHN-01) 及び従来流動食 (SBF) の食後血糖値及びインスリン分泌量の比較. 日本病態栄養学会誌 6 : 303-309、2003. – reference: 14) Pancorbo-H PL, García-FFP, Ramírez-P C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs 10: 482-490, 2001. – reference: 18) American Diabetes Association. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care Sup1 26: S51-S61, 2003. – reference: 22) Pohl M, Mayr P, Mertl-Roetzer M, et al. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomized controlled trial. Eur J Clin Nutr 59: 1221-1232, 2005. – reference: 27) 日本静脈経腸栄養学会編. 静脈経腸栄養ガイドライン第2版. 南江堂、東京、2006. – reference: 13) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med 2008; 358:2545-2559, 2008. – reference: 15) Arinzon Z, Shabat S, Shuval I, et al. Prevalence of diabetes mellitus in elderly patients received enteral nutrition longterm care service. Arch Gerontol Geriatr 47: 383-393, 2008. – reference: 4) Latham R, Lancaster AD, Covington JF, et al. The association of diabetes and glucose control with surgical site infections among cardiothoracic surgery patients. Infec Control Hosp Epidemiol 22: 607-612, 2001. – reference: 16) Garg A, et al. Comparison of a high carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin-dependent diabetes mellitus. N Engl J Med 319: 29-834, 1988. – reference: 20) The diabetes and nutrition study group of the European Aassociation for the Study of Diabetes. Recommedations for the nutritional management of patients with diabetes mellitus. Europian Jounal of clinical nutrition 54: 353-355, 2000. – reference: 25) 森豊、大田照男、田中孝明ほか. CGMを用いて評価した糖尿病患者の24時間血糖変動に及ぼす低GI (Glycemic Index)・GL (Glycemic Load) 流動食と低GI流動食の比較 静脈経腸栄養 26 : 1125-1131、2011. |
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| Title | 糖代謝異常 |
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