联合饮食与身体活动促进项目预防高危人群2型糖尿病：社区预防服务工作组的系统评价
Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force.
作者信息
Balk Ethan M, Earley Amy, Raman Gowri, Avendano Esther A, Pittas Anastassios G, Remington Patrick L
出版信息
Ann Intern Med. 2015 Sep 15;163(6):437-51. doi: 10.7326/M15-0452.
BACKGROUND
Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes.
PURPOSE
To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia.
DATA SOURCES
MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction.
STUDY SELECTION
8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes.
DATA EXTRACTION
7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality.
DATA SYNTHESIS
53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective.
LIMITATIONS
Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse.
CONCLUSION
Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective.
PRIMARY FUNDING SOURCE
Centers for Disease Control and Prevention Community Preventive Services Task Force.
背景
试验表明，严格的饮食和体育活动促进计划对于降低2型糖尿病发病风险增加的成年人的糖尿病发病率及改善血糖指标具有疗效。
目的
评估2型糖尿病发病风险增加人群的饮食和体育活动促进计划，主要目的是降低糖尿病风险、减轻体重并降低血糖水平。
数据来源
1991年至2015年2月27日期间的MEDLINE、Cochrane对照试验中心注册库、CAB文摘数据库、《全球健康》及Ovid健康之星数据库，无语言限制。
研究选择
8名研究人员筛选文章，寻找针对2型糖尿病发病风险增加的参与者开展的、为期至少3个月且至少有2次课程的饮食与体育活动促进综合计划的单组或比较研究。
数据提取
7名研究人员提取了有关研究设计、参与者、干预措施和结果描述以及结果的数据，并评估了研究质量。
数据综合
53项研究（30项为饮食与体育活动促进计划与常规护理的对比研究，13项为强化程度较高与较低的计划的对比研究，13项为单一计划研究）评估了66项计划。与常规护理相比，饮食与体育活动促进计划降低了2型糖尿病发病率（风险比[RR]，0.59[95%CI，0.52至0.66]）（16项研究），减轻了体重（净变化，-2.2%[CI，-2.9%至-1.4%]）（24项研究）以及空腹血糖水平（净变化，-0.12 mmol/L[-2.2 mg/dL][CI，-0.20至-0.05 mmol/L{-3.6至-0.9 mg/dL}]）（17项研究），并改善了其他心血管代谢危险因素。关于临床事件的证据有限。强化程度较高的计划更有效。
局限性
饮食和体育活动促进计划差异很大，限制了对与有效性最相关特征的识别。关于临床结局和儿童的证据稀少。
结论
饮食与体育活动促进综合计划在降低糖尿病发病率及改善发病风险增加人群的心血管代谢危险因素方面有效。强化程度较高的计划更有效力。
主要资金来源
疾病控制与预防中心社区预防服务工作组。
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