Division of Endocrinology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Diabetes Care. 2010 Jun;33(6):1153-8. doi: 10.2337/dc09-2090. Epub 2010 Mar 23.
To examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with type 2 diabetes.
Look AHEAD is a multicenter randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45-76 years. An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension, and hyperlipidemia were compared at baseline and 1 year. Medication costs were conservatively estimated using prices from a national online pharmacy.
Participants randomized to an ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared with those assigned to DSE. At 1 year, average number of medications prescribed to treat CVD risk factors was 3.1 +/- 1.8 for the ILI group and 3.6 +/- 1.8 for the DSE group (P < 0.0001), with estimated total monthly medication costs of $143 and $173, respectively (P < 0.0001). DSE participants meeting optimal care goals at 1 year were taking an average of 3.8 +/- 1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2 +/- 1.7) at lower cost ($154/month) (P < 0.001).
At 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.
研究通过生活方式干预减轻体重和提高身体适应性对 2 型糖尿病患者心血管疾病（CVD）风险因素治疗药物的使用和费用的影响。
Look AHEAD 是一项针对 5145 名超重或肥胖 2 型糖尿病患者的多中心随机对照试验，年龄在 45-76 岁之间。一项强化生活方式干预（ILI）包括小组和个人会议，通过减少热量摄入和增加身体活动来实现和维持体重减轻，与糖尿病支持和教育（DSE）条件进行比较。在基线和 1 年时比较了治疗糖尿病、高血压和高脂血症的处方药物。使用全国在线药店的价格保守估计药物费用。
与分配到 DSE 的患者相比，随机分到 ILI 的患者 CVD 风险参数有显著改善，药物使用和费用降低。在 1 年时，ILI 组治疗 CVD 风险因素的处方药物平均数量为 3.1 +/- 1.8 种，DSE 组为 3.6 +/- 1.8 种（P < 0.0001），估计每月药物费用分别为 143 美元和 173 美元（P < 0.0001）。在 1 年时达到最佳护理目标的 DSE 参与者平均服用 3.8 +/- 1.6 种药物，估计每月费用为 194 美元。达到最佳护理的 ILI 参与者需要较少的药物（3.2 +/- 1.7），费用更低（154 美元/月）（P < 0.001）。
在 1 年内，ILI 显著改善了 CVD 风险因素，同时减少了药物的使用和费用。持续的干预和随访将确定这些变化是否得到维持，并降低心血管风险。
