生活方式干预对2型糖尿病患者体重及心血管危险因素的长期影响：Look AHEAD试验的四年结果
Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.
作者信息
Wing Rena R
机构信息
Department of Psychiatry, The Miriam Hospital/Brown Medical School, Providence, RI 02860, USA.
出版信息
Arch Intern Med. 2010 Sep 27;170(17):1566-75. doi: 10.1001/archinternmed.2010.334.
BACKGROUND
Lifestyle interventions produce short-term improvements in glycemia and cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus, but no long-term data are available. We examined the effects of lifestyle intervention on changes in weight, fitness, and CVD risk factors during a 4-year study.
METHODS
The Look AHEAD (Action for Health in Diabetes) trial is a multicenter randomized clinical trial comparing the effects of an intensive lifestyle intervention (ILI) and diabetes support and education (DSE; the control group) on the incidence of major CVD events in 5145 overweight or obese individuals (59.5% female; mean age, 58.7 years) with type 2 diabetes mellitus. More than 93% of participants provided outcomes data at each annual assessment.
RESULTS
Averaged across 4 years, ILI participants had a greater percentage of weight loss than DSE participants (-6.15% vs -0.88%; P < .001) and greater improvements in treadmill fitness (12.74% vs 1.96%; P < .001), hemoglobin A(1c) level (-0.36% vs -0.09%; P < .001), systolic (-5.33 vs -2.97 mm Hg; P < .001) and diastolic (-2.92 vs -2.48 mm Hg; P = .01) blood pressure, and levels of high-density lipoprotein cholesterol (3.67 vs 1.97 mg/dL; P < .001) and triglycerides (-25.56 vs -19.75 mg/dL; P < .001). Reductions in low-density lipoprotein cholesterol levels were greater in DSE than ILI participants (-11.27 vs -12.84 mg/dL; P = .009) owing to greater use of medications to lower lipid levels in the DSE group. At 4 years, ILI participants maintained greater improvements than DSE participants in weight, fitness, hemoglobin A(1c) levels, systolic blood pressure, and high-density lipoprotein cholesterol levels.
CONCLUSIONS
Intensive lifestyle intervention can produce sustained weight loss and improvements in fitness, glycemic control, and CVD risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in CVD events will ultimately be addressed by the Look AHEAD trial.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT00017953.
背景
生活方式干预可使2型糖尿病患者的血糖及心血管疾病（CVD）危险因素在短期内得到改善，但尚无长期数据。我们在一项为期4年的研究中，考察了生活方式干预对体重、体能及CVD危险因素变化的影响。
方法
“展望未来（糖尿病健康行动）”试验是一项多中心随机临床试验，比较强化生活方式干预（ILI）与糖尿病支持及教育（DSE；对照组）对5145例超重或肥胖的2型糖尿病患者（女性占59.5%；平均年龄58.7岁）主要CVD事件发生率的影响。超过93%的参与者在每次年度评估时提供了结局数据。
结果
在4年的时间里，ILI组参与者的体重减轻百分比高于DSE组（-6.15%对-0.88%；P<.001），跑步机体能改善程度更大（12.74%对1.96%；P<.001），糖化血红蛋白A1c水平降低幅度更大（-0.36%对-0.09%；P<.001），收缩压（-5.33对-2.97 mmHg；P<.001）和舒张压（-2.92对-2.48 mmHg；P=.01）下降，高密度脂蛋白胆固醇水平升高（3.67对1.97 mg/dL；P<.001），甘油三酯水平降低（-25.56对-19.75 mg/dL；P<.001）。由于DSE组更多地使用药物降低血脂水平，DSE组参与者的低密度脂蛋白胆固醇水平降低幅度大于ILI组（-11.27对-12.84 mg/dL；P=.009）。在4年时，ILI组参与者在体重、体能、糖化血红蛋白A1c水平、收缩压和高密度脂蛋白胆固醇水平方面的改善程度仍大于DSE组。
结论
强化生活方式干预可使2型糖尿病患者持续减重，并改善体能、血糖控制及CVD危险因素。这些危险因素的差异是否会转化为CVD事件的减少，最终将由“展望未来”试验来解答。
试验注册
clinicaltrials.gov标识符：NCT00017953。
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