生活方式干预对糖耐量受损人群的心血管死亡率、全因死亡率和糖尿病发病率的影响：大庆糖尿病预防研究 23 年随访研究。

Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study.

机构信息

Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China; Center of Endocrinology and Cardiovascular Disease, National Center of Cardiology & Fuwai Hospital, Beijing, China.

Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA.

出版信息

Lancet Diabetes Endocrinol. 2014 Jun;2(6):474-80. doi: 10.1016/S2213-8587(14)70057-9. Epub 2014 Apr 3.

DOI:10.1016/S2213-8587(14)70057-9

PMID:24731674

Abstract

BACKGROUND

Lifestyle interventions among people with impaired glucose tolerance reduce the incidence of diabetes, but their effect on all-cause and cardiovascular disease mortality is unclear. We assessed the long-term effect of lifestyle intervention on long-term outcomes among adults with impaired glucose tolerance who participated in the Da Qing Diabetes Prevention Study.

METHODS

The study was a cluster randomised trial in which 33 clinics in Da Qing, China-serving 577 adults with impaired glucose tolerance-were randomised (1:1:1:1) to a control group or lifestyle intervention groups (diet or exercise or both). Patients were enrolled in 1986 and the intervention phase lasted for 6 years. In 2009, we followed up participants to assess the primary outcomes of cardiovascular mortality, all-cause mortality, and incidence of diabetes in the intention-to-treat population.

FINDINGS

Of the 577 patients, 439 were assigned to the intervention group and 138 were assigned to the control group (one refused baseline examination). 542 (94%) of 576 participants had complete data for mortality and 568 (99%) contributed data to the analysis. 174 participants died during the 23 years of follow-up (121 in the intervention group vs 53 in the control group). Cumulative incidence of cardiovascular disease mortality was 11.9% (95% CI 8.8-15.0) in the intervention group versus 19.6% (12.9-26.3) in the control group (hazard ratio [HR] 0.59, 95% CI 0.36-0.96; p=0.033). All-cause mortality was 28.1% (95% CI 23.9-32.4) versus 38.4% (30.3-46.5; HR 0.71, 95% CI 0.51-0.99; p=0.049). Incidence of diabetes was 72.6% (68.4-76.8) versus 89.9% (84.9-94.9; HR 0.55, 95% CI 0.40-0.76; p=0.001).

INTERPRETATION

A 6-year lifestyle intervention programme for Chinese people with impaired glucose tolerance can reduce incidence of cardiovascular and all-cause mortality and diabetes. These findings emphasise the long-term clinical benefits of lifestyle intervention for patients with impaired glucose tolerance and provide further justification for adoption of lifestyle interventions as public health measures to control the consequences of diabetes.

FUNDING

Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, Da Qing First Hospital.

摘要

背景

在糖耐量受损的人群中进行生活方式干预可降低糖尿病的发病率，但它们对全因和心血管疾病死亡率的影响尚不清楚。我们评估了生活方式干预对参加大庆糖尿病预防研究的糖耐量受损成年人的长期结局的长期影响。

方法

该研究是一项在中国大庆进行的群组随机试验，33 家诊所（服务于 577 名糖耐量受损的成年人）被随机分为对照组或生活方式干预组（饮食或运动或两者兼有）（1:1:1:1）。患者于 1986 年入组，干预阶段持续 6 年。2009 年，我们对参与者进行了随访，以评估意向治疗人群中心血管死亡率、全因死亡率和糖尿病发病率的主要结局。

结果

在 577 名患者中，439 名被分配到干预组，138 名被分配到对照组（1 名拒绝基线检查）。576 名参与者中有 542 名（94%）有完整的死亡率数据，568 名（99%）提供了分析数据。在 23 年的随访中，有 174 名参与者死亡（干预组 121 名，对照组 53 名）。干预组心血管疾病死亡率的累积发生率为 11.9%（95%CI 8.8-15.0），对照组为 19.6%（12.9-26.3）（风险比[HR]0.59，95%CI 0.36-0.96；p=0.033）。全因死亡率为 28.1%（95%CI 23.9-32.4），对照组为 38.4%（30.3-46.5；HR 0.71，95%CI 0.51-0.99；p=0.049）。糖尿病发病率为 72.6%（68.4-76.8），对照组为 89.9%（84.9-94.9；HR 0.55，95%CI 0.40-0.76；p=0.001）。