Massachusetts General Hospital Diabetes Center, 50 Staniford St Suite 340, Boston, MA 02114, United States.
Prev Med. 2017 Nov;104:120-123. doi: 10.1016/j.ypmed.2017.07.022. Epub 2017 Jul 28.
The American Diabetes Association nutrition and lifestyle recommendations for prediabetes and type 2 diabetes focus on losing 7% of body weight and increasing physical activity to at least 150minperweek. This emphasis is largely based on results of the Diabetes Prevention Program (DPP) and Look AHEAD (Action for Health in Diabetes) clinical trials. DPP demonstrated that a lifestyle intervention aimed at 7% weight loss and 150min of activity per week reduced diabetes incidence by 58% after 2.8years of follow-up and resulted in sustained improvements in hemoglobinA1c, blood pressure and lipid levels. After 15years of follow-up, DPP's lifestyle intervention sustained a 27% risk reduction in progression to diabetes. Look AHEAD's lifestyle intervention significantly reduced hemoglobinA1c, blood pressure, triglycerides, and the amount and costs of medications needed to treat these conditions when compared with diabetes support and education. Other clinical and psychological benefits achieved with lifestyle intervention were greater reductions in c-reactive protein, less self-reported retinopathy, reduced risk of nephropathy, less sexual dysfunction, decreased incidence of urinary incontinence and fatty liver, remission of sleep apnea, better physical functioning, less knee pain, more remission of diabetes, reduced incidence of depression, less body image dissatisfaction and improved quality-of-life. A number of DPP translation studies have demonstrated weight losses of 4 to 7% at 6month and 1year follow-up which has led to Medicare coverage for CDC recognized DPP lifestyle programs starting in April 2018. Translation studies of Look AHEAD using a variety of delivery formats are underway.
美国糖尿病协会针对糖尿病前期和 2 型糖尿病患者的营养和生活方式建议，重点是减轻体重 7%，并将身体活动量增加到每周至少 150 分钟。这一重点主要基于糖尿病预防计划（DPP）和前瞻性糖尿病行动研究（Look AHEAD）临床试验的结果。DPP 表明，旨在减轻 7%体重和每周进行 150 分钟活动的生活方式干预措施，在 2.8 年的随访后可使糖尿病发病率降低 58%，并持续改善血红蛋白 A1c、血压和血脂水平。随访 15 年后，DPP 的生活方式干预措施使糖尿病进展的风险降低了 27%。与糖尿病支持和教育相比，Look AHEAD 的生活方式干预显著降低了血红蛋白 A1c、血压、甘油三酯以及治疗这些疾病所需的药物数量和费用。生活方式干预还带来了其他临床和心理益处，包括 C 反应蛋白的减少、自我报告的视网膜病变减少、肾病风险降低、性功能障碍减少、尿失禁和脂肪肝的发生率降低、睡眠呼吸暂停的缓解、身体机能的改善、膝关节疼痛的减少、糖尿病缓解的增加、抑郁发生率的降低、身体形象不满的减少以及生活质量的提高。一些 DPP 翻译研究表明，在 6 个月和 1 年的随访中，体重减轻了 4%至 7%，这导致医疗保险自 2018 年 4 月起覆盖了疾控中心认可的 DPP 生活方式项目。正在进行使用各种传递形式的 Look AHEAD 翻译研究。
