基于跨文化糖尿病特异性营养算法（tDNA）对2型糖尿病患者进行结构化生活方式干预：一项随机对照试验。
Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial.
作者信息
Chee Winnie S S, Gilcharan Singh Harvinder Kaur, Hamdy Osama, Mechanick Jeffrey I, Lee Verna K M, Barua Ankur, Mohd Ali Siti Zubaidah, Hussein Zanariah
机构信息
Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia.
Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, USA.
出版信息
BMJ Open Diabetes Res Care. 2017 Sep 26;5(1):e000384. doi: 10.1136/bmjdrc-2016-000384. eCollection 2017.
OBJECTIVE
Trans-cultural diabetes nutrition algorithm (tDNA) was created by international task force and culturally customized for Malaysian population. This study was designed to evaluate its effectiveness versus usual diabetes care in primary care settings.
RESEARCH DESIGN AND METHODS
We randomized 230 patients with overweight/obesity, type 2 diabetes, and glycated hemoglobin (A1c) 7%-11% to receive usual care (UC) or UC with tDNA for 6 months. The tDNA intervention consisted of structured low-calorie meal plan, diabetes-specific meal replacements, and increased physical activity. Participants were counseled either through motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice through conventional counseling. All patients were followed for another 6 months after intervention.
RESULTS
At 6 months, A1c decreased significantly in tDNA-MI (-1.1±0.1%, p<0.001) and tDNA-CC (-0.5±0.1%, p=0.001) but not in UC (-0.2±0.1%, p=NS). Body weight decreased significantly in tDNA-MI (-6.9±1.3 kg, p<0.001) and tDNA-CC (-5.3±1.2 kg, p<0.001) but not in UC (-0.8±0.5 kg, p=NS). tDNA-MI patients had significantly lower fasting plasma glucose (tDNA-MI: -1.1±0.3 mmol/L, p<0.001; tDNA-CC: -0.6±0.3 mmol/L, p=NS; UC: 0.1±0.3 mmol/L, p=NS) and systolic blood pressure (tDNA-MI: -9±2 mm Hg, p<0.001; tDNA-CC: -9±2 mm Hg, p=0.001; UC: -1±2 mm Hg, p=NS). At 1 year, tDNA-MI patients maintained significant reduction in A1c (tDNA-MI: -0.5±0.2%, p=0.006 vs tDNA-CC: 0.1±0.2%, p=NS and UC: 0.02±0.01%, p=NS) and significant weight loss (tDNA-MI: -5.8±1.3 kg, p<0.001 vs tDNA-CC: -3.3±1.2 kg, p=NS and UC: 0.5±0.6 kg, p=NS).
CONCLUSIONS
Structured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing significantly improved diabetes control and body weight in primary care setting.
目的
跨文化糖尿病营养算法（tDNA）由国际特别工作组创建，并针对马来西亚人群进行了文化定制。本研究旨在评估其在初级保健环境中相对于常规糖尿病护理的有效性。
研究设计与方法
我们将230例超重/肥胖、2型糖尿病且糖化血红蛋白（A1c）为7%-11%的患者随机分为两组，一组接受常规护理（UC），另一组接受UC联合tDNA，为期6个月。tDNA干预包括结构化低热量饮食计划、糖尿病专用代餐以及增加身体活动。通过动机性访谈（tDNA-MI）或传统咨询（tDNA-CC）对参与者进行指导。UC组通过传统咨询接受标准饮食和运动建议。干预后所有患者再随访6个月。
结果
6个月时，tDNA-MI组（-1.1±0.1%，p<0.001）和tDNA-CC组（-0.5±0.1%，p=0.001）的A1c显著下降，而UC组（-0.2±0.1%，p=无统计学意义）未下降。tDNA-MI组（-6.9±1.3 kg，p<0.001）和tDNA-CC组（-5.3±1.2 kg，p<0.001）的体重显著下降，而UC组（-0.8±0.5 kg，p=无统计学意义）未下降。tDNA-MI组患者的空腹血糖显著降低（tDNA-MI：-1.1±0.3 mmol/L，p<0.001；tDNA-CC：-0.6±0.3 mmol/L，p=无统计学意义；UC：0.1±0.3 mmol/L，p=无统计学意义）和收缩压显著降低（tDNA-MI：-9±2 mmHg，p<0.001；tDNA-CC：-9±2 mmHg，p=0.001；UC：-1±2 mmHg，p=无统计学意义）。1年时，tDNA-MI组患者的A1c仍显著降低（tDNA-MI：-0.5±0.2%，p=0.006，与tDNA-CC组：0.1±0.2%，p=无统计学意义和UC组：0.02±0.01%，p=无统计学意义相比），且体重显著减轻（tDNA-MI：-5.8±1.3 kg，p<0.001，与tDNA-CC组：-3.3±1.2 kg，p=无统计学意义和UC组：0.5±0.6 kg，p=无统计学意义相比）。
结论
通过文化适应的营养算法和动机性访谈进行的结构化生活方式干预在初级保健环境中显著改善了糖尿病控制和体重。
Zotero 插件