2 型糖尿病患者饮食减肥后群体认知行为疗法与体重反弹：随机对照 POWER 试验结果。
Group cognitive behavioural therapy and weight regain after diet in type 2 diabetes: results from the randomised controlled POWER trial.
机构信息
Section of Pharmacology, Vascular and Metabolic Diseases Section, Department of Internal Medicine, Erasmus MC - Office D435, 's Gravendijkwal 230, PO-Box 2040, 3000 CA, Rotterdam, the Netherlands.
Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands.
出版信息
Diabetologia. 2018 Apr;61(4):790-799. doi: 10.1007/s00125-017-4531-9. Epub 2018 Jan 9.
AIMS/HYPOTHESIS: Weight-loss programmes for adults with type 2 diabetes are less effective in the long term owing to regain of weight. Our aim was to determine the 2 year effectiveness of a cognitive behavioural group therapy (group-CBT) programme in weight maintenance after diet-induced weight loss in overweight and obese adults with type 2 diabetes, using a randomised, parallel, non-blinded, pragmatic study design.
METHODS
We included 158 obese adults (median BMI 36.3 [IQR 32.5-40.0] kg/m) with type 2 diabetes from the outpatient diabetes clinic of Erasmus MC, the Netherlands, who achieved ≥5% weight loss on an 8 week very low calorie diet. Participants were randomised (stratified by weight loss) to usual care or usual care plus group-CBT (17 group sessions). The primary outcomes were the between-group differences after 2 years in: (1) body weight; and (2) weight regain. Secondary outcomes were HbA levels, insulin dose, plasma lipid levels, depression, anxiety, self-esteem, quality of life, fatigue, physical activity, eating disorders and related cognitions. Data were analysed using linear mixed modelling.
RESULTS
During the initial 8 week dieting phase, the control group (n = 75) lost a mean of 10.0 (95% CI 9.1, 10.9) kg and the intervention group (n = 83) lost 9.2 (95% CI 8.4, 10.0) kg (p = 0.206 for the between-group difference). During 2 years of follow-up, mean weight regain was 4.7 (95% CI 3.0, 6.3) kg for the control group and 4.0 (95% CI 2.3, 5.6) kg for the intervention group, with a between-group difference of -0.7 (95% CI -3.1, 1.6) kg (p = 0.6). The mean difference in body weight at 2 years was -1.2 (95% CI -7.7, 5.3) kg (p = 0.7). None of the secondary outcomes differed between the two groups.
CONCLUSIONS/INTERPRETATION: Despite increased treatment contact, a group-CBT programme for long-term weight maintenance after an initial ≥5% weight loss from dieting in obese individuals with type 2 diabetes was not superior to usual care alone.
TRIAL REGISTRATION
Trialregister.nl NTR2264 FUNDING: The study was funded by the Erasmus MC funding programme 'Zorgonderzoek' (grant 2008-8303).
目的/假设：由于体重反弹，针对 2 型糖尿病成年人的减肥计划在长期效果上较差。我们的目的是使用随机、平行、非盲、实用研究设计，确定在荷兰鹿特丹伊拉斯谟医疗中心的门诊糖尿病诊所中，超重和肥胖的 2 型糖尿病成年人在节食减肥后接受认知行为团体治疗（团体-CBT）计划对体重维持的 2 年有效性，该计划包括 158 名肥胖成年人（中位数 BMI 36.3 [IQR 32.5-40.0] kg/m），他们在进行为期 8 周的极低卡路里饮食后体重减轻了≥5%。参与者被随机（按体重减轻分层）分配至常规护理或常规护理加团体-CBT（17 次团体会议）。主要结局是在 2 年后组间差异：（1）体重；和（2）体重反弹。次要结局是 HbA 水平、胰岛素剂量、血浆脂质水平、抑郁、焦虑、自尊、生活质量、疲劳、身体活动、饮食失调和相关认知。使用线性混合模型进行数据分析。
结果
在最初的 8 周节食阶段，对照组（n=75）平均减轻了 10.0（95%CI 9.1，10.9）kg，干预组（n=83）减轻了 9.2（95%CI 8.4，10.0）kg（p=0.206 用于组间差异）。在 2 年的随访期间，对照组的平均体重反弹为 4.7（95%CI 3.0，6.3）kg，干预组为 4.0（95%CI 2.3，5.6）kg，组间差异为-0.7（95%CI -3.1，1.6）kg（p=0.6）。2 年后体重的平均差异为-1.2（95%CI -7.7，5.3）kg（p=0.7）。两组之间的次要结局均无差异。
结论/解释：尽管治疗接触增加，但在肥胖的 2 型糖尿病患者中，初始节食减肥后≥5%的体重减轻后，进行团体-CBT 计划进行长期体重维持并不优于单独常规护理。
试验注册
Trialregister.nl NTR2264 资助：该研究由鹿特丹伊拉斯谟医疗中心“Zorgonderzoek”资助计划（2008-8303 号拨款）资助。
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