Diabetes Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Hellsinki, Finland.
Diabetologia. 2013 Feb;56(2):284-93. doi: 10.1007/s00125-012-2752-5. Epub 2012 Oct 24.
AIMS/HYPOTHESIS: This study aimed to determine whether lifestyle intervention lasting for 4 years affected diabetes incidence, body weight, glycaemia or lifestyle over 13 years among individuals at high risk of type 2 diabetes.
Overweight, middle-aged men (n = 172) and women (n = 350) with impaired glucose tolerance were randomised in 1993-1998 to an intensive lifestyle intervention group (n = 265), aiming at weight reduction, dietary modification and increased physical activity, or to a control group (n = 257) that received general lifestyle information. The primary outcome was a diagnosis of diabetes based on annual OGTTs. Secondary outcomes included changes in body weight, glycaemia, physical activity and diet. After active intervention (median 4 years, range 1-6 years), participants still free of diabetes and willing to continue their participation (200 in the intervention group and 166 in the control group) were further followed until diabetes diagnosis, dropout or the end of 2009, with a median total follow-up of 9 years and a time span of 13 years from baseline.
During the total follow-up the adjusted HR for diabetes (intervention group vs control group) was 0.614 (95% CI 0.478, 0.789; p < 0.001). The corresponding HR during the post-intervention follow-up was 0.672 (95% CI 0.477, 0.947; p = 0.023). The former intervention group participants sustained lower absolute levels of body weight, fasting and 2 h plasma glucose and a healthier diet. Adherence to lifestyle changes during the intervention period predicted greater risk reduction during the total follow-up.
CONCLUSIONS/INTERPRETATION: Lifestyle intervention in people at high risk of type 2 diabetes induces sustaining lifestyle change and results in long-term prevention of progression to type 2 diabetes.
目的/假设：本研究旨在确定持续 4 年的生活方式干预是否会影响高患 2 型糖尿病风险人群的糖尿病发病率、体重、血糖或生活方式，随访时间长达 13 年。
1993 年至 1998 年，随机将 172 名超重、中年男性和 350 名糖耐量受损的女性分为强化生活方式干预组（n=265）和对照组（n=257）。干预组的目标是减肥、饮食调整和增加身体活动，对照组则接受一般生活方式信息。主要结局是基于年度 OGTT 的糖尿病诊断。次要结局包括体重、血糖、身体活动和饮食的变化。在积极干预（中位数 4 年，范围 1-6 年）后，仍然没有糖尿病且愿意继续参与的参与者（干预组 200 名，对照组 166 名）进一步随访，直到发生糖尿病诊断、退出或 2009 年底，中位总随访时间为 9 年，从基线开始随访时间跨度为 13 年。
在总随访期间，糖尿病的调整后 HR（干预组与对照组）为 0.614（95%CI 0.478，0.789；p<0.001）。干预后随访期间的相应 HR 为 0.672（95%CI 0.477，0.947；p=0.023）。前干预组参与者的体重、空腹和 2 小时血浆葡萄糖水平以及饮食更健康。干预期间生活方式改变的坚持程度预测了总随访期间更大的风险降低。
结论/解释：对高患 2 型糖尿病风险人群进行生活方式干预可促使其维持生活方式改变，并长期预防 2 型糖尿病进展。
