Huizinga Mary Margaret, Niswender Kevin D, Gebretsadik Tebeb, Rothman Russell L, Shintani Ayumi K, Elasy Tom A
Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Obesity (Silver Spring). 2008 Aug;16(8):1933-7. doi: 10.1038/oby.2008.301. Epub 2008 Jun 12.
Intensification of glycemic control is associated with weight gain, however, less is known about weight change during the maintenance phase of glycemic management. On the basis of current models of energy homeostasis, we hypothesize that insulin use will result in less weight gain than oral antidiabetic agents in patients with well-controlled diabetes. This is a prospective cohort nested within a randomized control trial at an academic clinic, with enrollment from June 2002 to January 2005. A total of 163 patients with type 2 diabetes were enrolled after obtaining glycemic control. Insulin use was assessed by self-report at baseline. Participants were weighed at baseline and five follow-up visits over 24 months. The weight change was compared between insulin users and noninsulin users. The average (s.d.) age was 55 (11), 44% are female and 21% are black. The median duration of diabetes was 5 (0.5-10) years. At baseline, 88 participants (54%) reported insulin use with an average of 69 (6) units/day. Baseline BMI in the insulin users was 35 (6) and 33 (6) in noninsulin patients. Over 24 months, noninsulin patients gained 2.3 additional kilograms compared with insulin users (2.8 kg (6.8) vs. 0.5 kg (6.5), P = 0.065). After adjusting for age, race, sex, baseline weight, intervention status, and change in A1C, insulin users had 2.5 kg less weight gain than noninsulin users (P = 0.033). Less weight gain was observed over 24 months in insulin-treated patients. Whether this effect may be due to central catabolic effects of insulin merits additional confirmatory study and mechanistic investigation.
强化血糖控制与体重增加有关，然而，对于血糖管理维持阶段的体重变化了解较少。基于当前的能量平衡模型，我们推测在糖尿病控制良好的患者中，使用胰岛素导致的体重增加将少于口服抗糖尿病药物。这是一项前瞻性队列研究，嵌套于一家学术诊所的随机对照试验中，于2002年6月至2005年1月进行入组。共有163例2型糖尿病患者在实现血糖控制后入组。通过基线时的自我报告评估胰岛素使用情况。在基线以及24个月内的五次随访时对参与者进行称重。比较胰岛素使用者和非胰岛素使用者之间的体重变化。平均（标准差）年龄为55（11）岁，44%为女性，21%为黑人。糖尿病病程中位数为5（0.5 - 10）年。在基线时，88名参与者（54%）报告使用胰岛素，平均每日剂量为69（6）单位。胰岛素使用者的基线体重指数为35（6），非胰岛素使用者为33（6）。在24个月期间，与胰岛素使用者相比，非胰岛素使用者体重额外增加2.3千克（2.8千克（6.8）对0.5千克（6.5），P = 0.065）。在调整年龄、种族、性别、基线体重、干预状态和糖化血红蛋白变化后，胰岛素使用者的体重增加比非胰岛素使用者少2.5千克（P = 0.033）。在接受胰岛素治疗的患者中，24个月内观察到体重增加较少。这种效应是否可能归因于胰岛素的中枢分解代谢作用，值得进一步的验证性研究和机制研究。
