Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina 27705, USA.
J Am Geriatr Soc. 2012 Sep;60(9):1655-62. doi: 10.1111/j.1532-5415.2012.04119.x.
To determine whether a home-based multicomponent physical activity counseling (PAC) intervention is effective in reducing glycemic measures in older outpatients with prediabetes mellitus.
Controlled clinical trial.
Primary care clinics of the Durham Veterans Affairs (VA) Medical Center between September 29, 2008, and March 25, 2010.
Three hundred two overweight (body mass index 25-45 kg/m(2) ), older (60-89) outpatients with impaired glucose tolerance (fasting blood glucose 100-125 mg/dL, glycosylated hemoglobin (HbA1c) <7%) randomly assigned to a PAC intervention group (n = 180) or a usual care control group (n = 122).
A 12-month, home-based multicomponent PAC program including one in-person baseline counseling session, regular telephone counseling, physician endorsement in clinic with monthly automated encouragement, and customized mailed materials. All study participants, including controls, received a consultation in a VA weight management program.
The primary outcome was a homeostasis model assessment of insulin resistance (HOMA-IR), calculated from fasting insulin and glucose levels at baseline and 3 and 12 months. HbA1c was the secondary indicator of glycemic control. Other secondary outcomes were anthropometric measures and self-reported physical activity, health-related quality of life, and physical function.
There were no significant differences between the PAC and control groups over time for any of the glycemic indicators. Both groups had small declines over time of approximately 6% in fasting blood glucose (P < .001), and other glycemic indicators remained stable. The declines in glucose were not sufficient to affect the change in HOMA-IR scores due to fluctuations in insulin over time. Endurance physical activity increased significantly in the PAC group (P < .001) and not in the usual care group.
Home-based telephone counseling increased physical activity levels but was insufficient to improve glycemic indicators in older outpatients with prediabetes mellitus.
确定基于家庭的多组分体力活动咨询（PAC）干预是否可有效降低患有前驱糖尿病的老年门诊患者的血糖指标。
对照临床试验。
2008 年 9 月 29 日至 2010 年 3 月 25 日，位于美国北卡罗来纳州达勒姆的退伍军人事务部（VA）医疗中心的初级保健诊所。
302 名超重（体重指数 25-45kg/m2）、年龄在 60-89 岁之间、伴有葡萄糖耐量受损（空腹血糖 100-125mg/dL，糖化血红蛋白（HbA1c）<7%）的老年门诊患者，随机分为 PAC 干预组（n=180）或常规护理对照组（n=122）。
为期 12 个月的基于家庭的多组分 PAC 方案，包括一次面对面的基线咨询、定期电话咨询、在诊所中由医生定期进行的自动鼓励、以及个性化的邮寄材料。所有研究参与者，包括对照组，都接受了退伍军人事务部体重管理计划的咨询。
主要结局指标为稳态模型评估的胰岛素抵抗指数（HOMA-IR），由基线和 3 个月及 12 个月时的空腹胰岛素和血糖水平计算得出。糖化血红蛋白（HbA1c）是血糖控制的次要指标。其他次要结局指标为人体测量学指标以及自我报告的体力活动、健康相关生活质量和身体功能。
在任何血糖指标方面，PAC 组和对照组之间在随访期间均无显著差异。两组患者的空腹血糖均随时间呈小幅度下降（P<0.001），其他血糖指标保持稳定。由于胰岛素随时间的波动，血糖的下降不足以影响 HOMA-IR 评分的变化。PAC 组的耐力性体力活动显著增加（P<0.001），而常规护理组则没有增加。
基于家庭的电话咨询增加了体力活动水平，但不足以改善患有前驱糖尿病的老年门诊患者的血糖指标。
