Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Diabetes Care. 2018 May;41(5):1040-1048. doi: 10.2337/dc17-2110. Epub 2018 Mar 15.
The impact of weight loss intervention on disability-free life expectancy in adults with diabetes is unknown. We examined the impact of a long-term weight loss intervention on years spent with and without physical disability.
Overweight or obese adults with type 2 diabetes age 45-76 years ( = 5,145) were randomly assigned to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Physical function was assessed annually for 12 years using the 36-Item Short Form Health Survey. Annual incidence of physical disability, mortality, and disability remission were incorporated into a Markov model to quantify years of life spent active and physically disabled.
Physical disability incidence was lower in the ILI group (6.0% per year) than in the DSE group (6.8% per year) (incidence rate ratio 0.88 [95% CI 0.81-0.96]), whereas rates of disability remission and mortality did not differ between groups. ILI participants had a significant delay in moderate or severe disability onset and an increase in number of nondisabled years ( < 0.05) compared with DSE participants. For a 60-year-old, this effect translates to 0.9 more disability-free years (12.0 years [95% CI 11.5-12.4] vs. 11.1 years [95% CI 10.6-11.7]) but no difference in total years of life. In stratified analyses, ILI increased disability-free years of life in women and participants without cardiovascular disease (CVD) but not in men or participants with CVD.
Long-term lifestyle interventions among overweight or obese adults with type 2 diabetes may reduce long-term disability, leading to an effect on disability-free life expectancy but not on total life expectancy.
减重干预对糖尿病患者无残疾预期寿命的影响尚不清楚。我们研究了长期减重干预对有和无身体残疾年限的影响。
年龄在 45-76 岁（n=5145）的超重或肥胖 2 型糖尿病患者被随机分配到 10 年强化生活方式干预（ILI）或糖尿病支持和教育（DSE）组。使用 36 项简短健康调查问卷（SF-36），每年评估一次身体功能，共 12 年。将身体残疾的年度发生率、死亡率和残疾缓解率纳入马尔可夫模型，以量化活跃和身体残疾的年限。
ILI 组的身体残疾发生率（每年 6.0%）低于 DSE 组（每年 6.8%）（发生率比 0.88 [95%CI 0.81-0.96]），而两组的残疾缓解率和死亡率没有差异。与 DSE 组相比，ILI 组参与者中度或重度残疾发病时间明显延迟，无残疾年限增加（<0.05）。对于一个 60 岁的人来说，这种效果相当于 0.9 更多的无残疾年限（12.0 年[95%CI 11.5-12.4] vs. 11.1 年[95%CI 10.6-11.7]），但总寿命没有差异。在分层分析中，ILI 增加了女性和无心血管疾病（CVD）参与者的无残疾预期寿命，但对男性或有 CVD 参与者没有影响。
超重或肥胖 2 型糖尿病患者的长期生活方式干预可能会减少长期残疾，从而对无残疾预期寿命产生影响，但对总预期寿命没有影响。
