生玉米淀粉改善胰岛素瘤相关低血糖的疗效：一种有前景的支持治疗

doi:10.24920/004329

Chinese Medical Sciences Journaldoi: 10.24920/004329

• 论著 • 上一篇

生玉米淀粉改善胰岛素瘤相关低血糖的疗效：一种有前景的支持治疗

李融融¹, 陈伟^1*, 肖新华², 于淼², 平凡², 段炼²

¹中国医学科学院北京协和医学院北京协和医院临床营养科功能主食创制与慢病营养干预北京市重点实验室;
²内分泌科,北京 100730

收稿日期:2023-12-11 接受日期:2024-04-11 发布日期:2024-05-17

Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy

Rong-Rong Li¹, Wei Chen^1*, Xin-Hua Xiao², Miao Yu², Fan Ping², Lian Duan²

¹Department of Clinical Nutrition, Beijing Key Laboratory of the Innovative Development of Functional Staple and the Nutritional Intervention for Chronic Disease;
²Department of Endocrinology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Received:2023-12-11 Accepted:2024-04-11 Online:2024-05-17
Contact: ^*E-mail: txchenwei@sina.com

摘要/Abstract

摘要： 目的探讨补充生玉米淀粉（raw corn starch,RCS）对胰岛素瘤相关低血糖的疗效。
方法我们回顾性收集了术前接受RCS辅助饮食的胰岛素瘤患者的临床资料,分析了RCS干预对血糖和体重变化的效果以及不良反应。
结果研究纳入24例胰岛素瘤患者,男性7例,女性17例,年龄46.08岁±14.15岁。在补充RCS前,所有患者均有频繁的低血糖发作（2.51±3.88 次/周）,83.33%的患者伴有低血糖相关神经症状,75.0%的和患者伴有自主神经表现;空腹血糖为2.70（IQR: 2.50-2.90）mmol/L。患者接受RCS干预后,体重每月增加0.38（IQR: 0.05-0.65）kg,有8例（33.33%）患者出现超重,7例（29.17%）出现肥胖。所有患者均规律补充RCS直至完成原发病治疗（23例随后接受了肿瘤切除术,1例接受了肝转移灶的动脉化疗栓塞治疗）。19例患者全天均匀补充RCS,干预1周内的空腹血糖显著高于营养干预前水平[4.30（IQR: 3.30-5.70）mmol/L vs. 2.25（IQR: 1.60-2.90）mmol/L,P = 0.000];其中10例患者补充RCS超过4周,其空腹血糖较干预前显著改善[3.20（IQR: 2.60-3.95）mmol/L vs. 2.15（IQR: 1.83-2.33）mmol/L,P = 0.000]。另有5例患者仅在夜间补充RCS,在干预1周内空腹血糖也有显著提高[3.50（IQR: 2.50-3.65）mmol/L vs. 2.20（IQR: 1.80-2.60）mmol/L,P = 0.000];其中仅有1例患者继续接受超过4周的夜间补充RCS,空腹血糖没有显著改善。所有患者的体重并未因RCS补充而改善。2例患者现轻度腹泻,1例出现胀气,减少RCS剂量后症状缓解。
结论规律的补充RCS有助于改善胰岛素瘤引起的低血糖。

关键词: 玉米淀粉, 低血糖, 胰岛素瘤, 营养治疗

Abstract: Objective To investigate the efficacy of raw corn starch (RCS) in clinical management of insulinoma-induced hypoglycemia.
Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively, and analyzed the therapeutic effects of the RCS intervention on blood glucose control, weight change, and its adverse events.
Results The study population consisted of 24 case of insulinoma patients, 7 males and 17 females, aged 46.08 ± 14.15 years. Before RCS-supplemented diet, all patients had frequent hypoglycemic episodes (2.51 ± 3.88 times/week), concurrent with neuroglycopenia (in 83.3% of patients) and autonomic manifestations (in 75.0% of patients), with the median fasting blood glucose (FBG) of 2.70 [interquartile range (IQR): 2.50-2.90] mmol/L. The patients’ weight increased by 0.38 (IQR: 0.05-0.65) kg per month, with 8 (33.3%) cases developing overweight and 7 (29.2%) cases developing obesity. All patients maintained the RCS-supplemented diet until they underwent tumor resection (23 cases) and transarterial chemoembolization for liver metastases (1 case). For 19 patients receiving RCS throughout the day, the median FBG within one week of nutritional management was 4.30 (IQR: 3.30-5.70) mmol/L, which was a significant increase compared to pre-nutritional level [2.25 (IQR: 1.60-2.90) mmol/L; P = 0.000]. Of them, 10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment [3.20 (IQR: 2.60-3.95) mmol/L vs. 2.15 (IQR: 1.83-2.33) mmol/L; P = 0.000). Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management [3.50 (IQR: 2.50-3.65) mmol/L vs. 2.20 (IQR:1.80-2.60) mmol/L; P = 0.000], but only one patient who continued to receive RCS for over 4 weeks did not have a significant improvement in FBG. No improvement in weight gain was observed upon RCS supplementation. Mild diarrhea (2 cases) and flatulence (1 case) occurred, and were relieved by reduction of RCS dose.
Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

Key words: corn starch, hypoglycemia, insulinoma, nutrition therapy

Rong-Rong Li, Wei Chen, Xin-Hua Xiao, Miao Yu, Fan Ping, Lian Duan. Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy[J/OL].Chinese Medical Sciences Journal, .DOI:10.24920/004329.[Epub ahead of print].

参考文献

[1] Ellison TA, Edil BH.The current management of pancreatic neuroendocrine tumors. Adv Surg 2012; 46:283-96. doi: 10.1016/j.yasu.2012.04.002.
[2] Shao S, Zeng Z, Hu S.An observational analysis of insulinoma from a single institution. QJM 2018; 111(4):237-41. doi: 10.1093/qjmed/hcy006.
[3] Dardano A, Daniele G, Lupi R, et al.Nesidioblastosis and insulinoma: a rare coexistence and a therapeutic challenge. Front Endocrinol (Lausanne) 2020; 11:10. doi: 10.3389/fendo.2020.00010. eCollection 2020.
[4] Bhattacharya K.Dietary dilemmas in the management of glycogen storage disease type I. J Inherit Metab Dis 2011; 34(3):621-9. doi: 10.1007/s10545-011-9322-8.
[5] Ross KM, Brown LM, Corrado MM, et al.Safety and efficacy of chronic extended release cornstarch therapy for glycogen storage disease type I. JIMD Rep 2016; 26:85-90. doi: 10.1007/8904_2015_488.
[6] Axelsen M, Wesslau C, Lonnroth P, et al.Bedtime uncooked cornstarch supplement prevents nocturnal hypoglycaemia in intensively treated type 1 diabetes subjects. J Intern Med 1999; 245(3):229-36. doi: 10.1046/j.1365-2796.1999.00432.x.
[7] Axelsen M, Lönnroth P, Lenner RA, et al.Suppression of nocturnal fatty acid concentrations by bedtime carbohydrate supplement in type 2 diabetes: effects on insulin sensitivity, lipids, and glycemic control. Am J Clin Nutr 2000; 71(5):1108-14. doi: 10.1093/ajcn/71.5.1108.
[8] Boneh A, Landau H, Abramovitch N.Raw cornstarch as an additional therapy in nesidioblastosis. Am J Clin Nutr 1988; 47(6):1001-3. doi: 10.1093/ajcn/47.6.1001.
[9] Deguchi A, Okauchi Y, Suehara S, et al.Insulin autoimmune syndrome in a health supplement user: the effectiveness of cornstarch therapy for treating hypoglycemia. Intern Med 2013; 52(3):369-72. doi: 10.2169/internalmedicine.52.7844.
[10] Lechner K, Aulinger B, Brand S, et al.Hydrothermally modified slow release corn starch: a potential new therapeutic option for treating hypoglycemia in autoimmune hypoglycemia (Hirata's disease). Eur J Clin Nutr 2015; 69(12):1369-70. doi: 10.1038/ejcn.2015.151.
[11] Lembo E, Lupoli R, Ciciola P, et al.Implementation of low glycemic index diet together with cornstarch in post-gastric bypass hypoglycemia: two case reports. Nutrients 2018; 10(6). doi: 10.3390/nu10060670.
[12] Bell SJ, Forse RA.Nutritional management of hypoglycemia. Diabetes Educ 1999; 25(1):41-7. doi: 10.1177/014572179902500106.
[13] Kishnani PS, Austin SL, Abdenur JE, et al.Diagnosis and management of glycogen storage disease type I: a practice guideline of the American College of Medical Genetics and Genomics. Genet Med 2014; 16(11):e1. doi: 10.1038/gim.2014.128.
[14] Chen YT, Cornblath M, Sidbury JB.Cornstarch therapy in type I glycogen-storage disease. N Engl J Med 1984; 310(3):171-5. doi: 10.1056/NEJM198401193100306.
[15] Heller S, Worona L, Consuelo A. Nutritional therapy for glycogen storage diseases. J Pediatr Gastroenterol Nutr2008; 47 Suppl 1:S15-21. doi: 10.1097/MPG.0b013e3181818ea5.
[16] Smit GP, Berger R, Potasnick R, et al.The dietary treatment of children with type I glycogen storage disease with slow release carbohydrate. Pediatr Res 1984; 18(9):879-81. doi: 10.1203/00006450-198409000-00015.
[17] Rokutan M, Yabe D, Komoto I, et al.A case of insulinoma with non-alcoholic fatty liver disease: Roles of hyperphagia and hyperinsulinemia in pathogenesis of the disease. Endocr J 2015; 62(11):1025-30. doi: 10.1507/endocrj.EJ14-0590.
[18] The Helen Diller Comprehensive Cancer Center. Diet tips for insulinoma.2015. Available from: https://neuroendocrine.ucsf.edu/sites/g/files/tkssra2606/f/wysiwyg/Insulinoma%20Diet_NET2015.pdf.
[19] Grant ER BK.Canine insulinoma: diagnosis, treatment, & staging. Today's Veterinary Practice 2016; 6(6):60-4.
[20] Goutal CM, Brugmann BL, Ryan KA.Insulinoma in dogs: a review. J Am Anim Hosp Assoc 2012; 48(3):151-63. doi: 10.5326/JAAHA-MS-5745.
[21] Bhattacharya K, Mundy H, Lilburn MF, et al.A pilot longitudinal study of the use of waxy maize heat modified starch in the treatment of adults with glycogen storage disease type I: a randomized double-blind cross-over study. Orphanet J Rare Dis 2015; 10:18. doi: 10.1186/s13023-015-0229-6.
[22] Correia CE, Bhattacharya K, Lee PJ, et al.Use of modified cornstarch therapy to extend fasting in glycogen storage disease types Ia and Ib. Am J Clin Nutr 2008; 88(5):1272-6. doi: 10.3945/ajcn.2008.26352.

优先出版

当期目次

过刊浏览

虚拟专题

作者中心

评阅者中心

生玉米淀粉改善胰岛素瘤相关低血糖的疗效：一种有前景的支持治疗

Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

Metrics

推荐阅读 1