Gilis-Januszewska Aleksandra, Lindström Jaana, Tuomilehto Jaakko, Piwońska-Solska Beata, Topór-Mądry Roman, Szybiński Zbigniew, Peltonen Markku, Schwarz Peter E H, Windak Adam, Hubalewska-Dydejczyk Alicja
Chair and Department of Endocrinology, Jagiellonian University, Medical College, Kopernika 17, 31-501, Kraków, Poland.
Chronic Disease Prevention Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.
BMC Public Health. 2017 Feb 15;17(1):198. doi: 10.1186/s12889-017-4104-3.
Real life implementation studies performed in different settings and populations proved that lifestyle interventions in prevention of type 2 diabetes can be effective. However, little is known about long term results of these translational studies. Therefore, the purpose of this study was to examine the maintenance of diabetes type 2 risk factor reduction achieved 1 year after intervention and during 3 year follow-up in primary health care setting in Poland.
Study participants (n = 262), middle aged, slightly obese, with increased type 2 diabetes risk ((age 55.5 (SD = 11.3), BMI 32 (SD = 4.8), Finnish Diabetes Risk Score FINDRISC 18.4 (SD = 2.9)) but no diabetes at baseline, were invited for 1 individual and 10 group lifestyle counselling sessions as well as received 6 motivational phone calls and 2 letters followed by organized physical activity sessions combined with counselling to increase physical activity. Measurements were performed at baseline and then repeated 1 and 3 years after the initiation of the intervention.
One hundred five participants completed all 3 examinations (baseline age 56.6 (SD = 10.7)), BMI 31.1 (SD = 4.9)), FINDRISC 18.57 (SD = 3.09)). Males comprised 13% of the group, 10% of the patients presented impaired fasting glucose (IFG) and 14% impaired glucose tolerance (IGT). Mean weight of participants decreased by 2.27 kg (SD = 5.25) after 1 year (p = <0.001). After 3 years a weight gain by 1.13 kg (SD = 4.6) (p = 0.04) was observed. In comparison with baseline however, the mean total weight loss at the end of the study was maintained by 1.14 kg (SD = 5.8) (ns). Diabetes risk (FINDRISC) declined after one year by 2.8 (SD = 3.6) (p = 0.001) and the decrease by 2.26 (SD = 4.27) was maintained after 3 years (p = 0.001). Body mass reduction by >5% was achieved after 1 and 3 years by 27 and 19% of the participants, respectively. Repeated measures analysis revealed significant changes observed from baseline to year 1 and year 3 in: weight (p = 0.048), BMI (p = 0.001), total cholesterol (p = 0.013), TG (p = 0.061), fasting glucose level (p = 0.037) and FINDRISC (p = 0.001) parameters. The conversion rate to diabetes was 2% after 1 year and 7% after 3 years.
Type 2 diabetes prevention in real life primary health care setting through lifestyle intervention delivered by trained nurses leads to modest weight reduction, favorable cardiovascular risk factors changes and decrease of diabetes risk. These beneficial outcomes can be maintained at a 3-year follow-up.
ISRCTN, ID ISRCTN96692060 , registered 03.08.2016 retrospectively.
在不同环境和人群中开展的实际生活实施研究证明，生活方式干预在预防2型糖尿病方面可能有效。然而，对于这些转化研究的长期结果知之甚少。因此，本研究的目的是在波兰的初级卫生保健环境中，检验干预1年后及3年随访期间实现的2型糖尿病危险因素降低情况的维持情况。
研究参与者（n = 262）为中年、轻度肥胖、2型糖尿病风险增加者（年龄55.5（标准差 = 11.3），体重指数32（标准差 = 4.8），芬兰糖尿病风险评分FINDRISC 18.4（标准差 = 2.9）），但基线时无糖尿病，被邀请参加1次个体和10次小组生活方式咨询会议，并收到6次激励性电话和2封信，随后是有组织的体育活动课程并结合咨询以增加体育活动。在基线时进行测量，然后在干预开始后1年和3年重复测量。
105名参与者完成了所有3次检查（基线年龄56.6（标准差 = 10.7）），体重指数31.1（标准差 = 4.9）），FINDRISC 18.57（标准差 = 3.09））。男性占该组的13%，10%的患者空腹血糖受损（IFG），14%的患者糖耐量受损（IGT）。1年后参与者的平均体重下降了2.27千克（标准差 = 5.25）（p = <0.001）。3年后观察到体重增加了1.13千克（标准差 = 4.6）（p = 0.04）。然而，与基线相比，研究结束时的平均总体重减轻维持在1.14千克（标准差 = 5.8）（无显著性差异）。1年后糖尿病风险（FINDRISC）下降了2.8（标准差 = 3.6）（p = 0.001），3年后维持下降2.26（标准差 = 4.27）（p = 0.001）。1年和3年后分别有27%和19%的参与者体重减轻超过5%。重复测量分析显示，从基线到第1年和第3年，在体重（p = 0.048）、体重指数（p = 0.001）、总胆固醇（p = 0.013）、甘油三酯（p = 0.061）、空腹血糖水平（p = 0.037）和FINDRISC（p = 0.001）参数方面观察到显著变化。1年后糖尿病转化率为2%，3年后为7%。
在现实生活中的初级卫生保健环境中，通过由经过培训的护士提供的生活方式干预预防2型糖尿病，可导致适度的体重减轻、有利的心血管危险因素变化以及糖尿病风险降低。这些有益结果在3年随访中可以维持。
ISRCTN，编号ISRCTN96692060，于2016年8月3日追溯注册。
