Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.
Diabetes Care. 2019 May;42(5):804-809. doi: 10.2337/dc18-2201. Epub 2019 Feb 14.
Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes.
Using data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model.
Of the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: -interaction = 0.08; % weight change: -interaction = 0.10).
A behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status.
鉴于严重精神疾病（SMI）患者中肥胖症和糖尿病的高发率，以及缺乏针对糖尿病 SMI 患者减肥计划效果的证据，我们评估了一项行为减肥干预措施在伴或不伴糖尿病的 SMI 参与者中的有效性。
利用 ACHIEVE 的数据，这是一项评估行为减肥干预对超重/肥胖 SMI 人群影响的随机对照试验，我们使用纵向混合效应模型评估了基线至 18 个月时伴或不伴糖尿病的参与者体重变化，并进行比较。
在 291 名试验参与者中，82 名（28.2%）参与者在基线时有糖尿病（干预组和对照组分别为 34 名和 48 名）。患有糖尿病的参与者更有可能服用抗精神病药物（31.7%对 18.7%，P=0.02）。在 18 个月时，对照组中患有糖尿病的参与者体重减轻了 1.2 磅（0.6%），而无糖尿病的参与者体重减轻了 0.8 磅（0.7%）。在干预组中，患有糖尿病的参与者体重减轻了 13.7 磅（6.6%），而无糖尿病的参与者体重减轻了 5.4 磅（2.9%）。相应的净效果（干预组减去对照组）在无糖尿病和糖尿病亚组中分别为 18 个月时体重减轻 4.6 磅（2.2%）和 12.5 磅（6.0%）。然而，干预效果的组间差异无统计学意义（绝对体重变化：-交互作用=0.08；体重变化百分比：-交互作用=0.10）。
行为减肥干预措施对超重和肥胖的 SMI 个体有效，无论其糖尿病状况如何。
