O'Neil Patrick M, Miller-Kovach Karen, Tuerk Peter W, Becker Lynne E, Wadden Thomas A, Fujioka Ken, Hollander Priscilla L, Kushner Robert F, Timothy Garvey W, Rubino Domenica M, Malcolm Robert J, Weiss Daniel, Raum William J, Salyer Jonny L, Hermayer Kathie L, Rost Stephanie L, Veliko Jan L, Sora Nicoleta D
Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, South Carolina, USA.
Weight Watchers International, New York, New York, USA.
Obesity (Silver Spring). 2016 Nov;24(11):2269-2277. doi: 10.1002/oby.21616.
Modest weight loss from clinical interventions improves glycemic control in type 2 diabetes (T2DM). Data are sparse on the effects of weight loss via commercial weight loss programs. This study examined the effects on glycemic control and weight loss of the standard Weight Watchers program, combined with telephone and email consultations with a certified diabetes educator (WW), compared with standard diabetes nutrition counseling and education (standard care, SC).
In a 12-month randomized controlled trial at 16 U.S. research centers, 563 adults with T2DM (HbA 7-11%; BMI 27-50 kg/m ) were assigned to either the commercially available WW program (regular community meetings, online tools), plus telephone and email counseling from a certified diabetes educator, or to SC (initial in-person diabetes nutrition counseling/education, with follow-up informational materials).
Follow-up rate was 86%. Twelve-month HbA changes for WW and SC were -0.32 and +0.16, respectively; 24% of WW versus 14% of SC achieved HbA <7.0% (P = 0.004). Weight losses were -4.0% for WW and -1.9% for SC (Ps < 0.001). 26% of WW versus 12% of SC reduced diabetes medications (P < 0.001). WW participants had greater reductions in waist circumference (P < 0.001) and C-reactive protein (P = 0.02) but did not differ on other cardiovascular risk factors.
Widely available commercial weight loss programs with community and online components, combined with scalable complementary diabetes education, may represent accessible and effective components of management plans for adults with overweight/obesity and T2DM.
临床干预带来的适度体重减轻可改善2型糖尿病（T2DM）患者的血糖控制。关于通过商业减肥项目实现体重减轻的效果的数据较为稀少。本研究比较了标准的慧俪轻体（Weight Watchers）项目（结合与认证糖尿病教育者的电话及电子邮件咨询，简称WW）与标准糖尿病营养咨询与教育（标准护理，简称SC）对血糖控制和体重减轻的影响。
在美国16个研究中心进行的一项为期12个月的随机对照试验中，563名T2DM成人患者（糖化血红蛋白[HbA]为7%-11%；体重指数[BMI]为27-50kg/m²）被随机分配至可商业化获取的WW项目组（定期社区会议、在线工具），并接受认证糖尿病教育者的电话及电子邮件咨询，或SC组（初始面对面糖尿病营养咨询/教育，并提供后续信息材料）。
随访率为86%。WW组和SC组的12个月HbA变化分别为-0.32和+0.16；WW组24%的患者与SC组14%的患者HbA<7.0%（P=0.004）。WW组体重减轻4.0%，SC组体重减轻1.9%（P<0.001）。WW组26%的患者与SC组12%的患者减少了糖尿病药物用量（P<0.001）。WW组参与者的腰围（P<0.001）和C反应蛋白（P=0.02）降低幅度更大，但在其他心血管危险因素方面无差异。
广泛可用的包含社区及在线部分的商业减肥项目，结合可扩展的补充性糖尿病教育，可能是超重/肥胖T2DM成人患者管理计划中可及且有效的组成部分。
