Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA.
Department of Statistics, University of Florida, Gainesville, Florida, USA.
BMJ Open Diabetes Res Care. 2019 May 28;7(1):e000653. doi: 10.1136/bmjdrc-2019-000653. eCollection 2019.
This study examined the effects of three doses of behavioral weight loss treatment, compared with a nutrition education control group, on changes in glycemic control in individuals with obesity and prediabetes.
The study included 287 adults (77% female, 81% White; mean (SD) age=54.1 (10.5) years, body mass index=36.3 (3.9) kg/m, and hemoglobin A1c (HbA1c)=5.9 (0.2%)). Participants were randomized to one of three behavioral treatment doses (high=24 sessions, moderate=16 sessions, or low=8 sessions) or to an education group (control=8 sessions). Changes in HbA1c, fasting glucose, and body weight were assessed from baseline to 6 months.
Mean (99.2% credible interval (CI)) reductions in HbA1c were 0.11% (0.07% to 0.16%), 0.08% (0.03% to 0.13%), 0.03% (-0.01% to 0.07%), and 0.02% (-0.02% to 0.07%), for the high, moderate, low, and control conditions, respectively. Mean (CI) reductions in fasting blood glucose were 0.26 mmol/L (0.14 to 0.39), 0.09 mmol/L (0 to 0.19), 0.01 mmol/L (-0.07 to 0.09), and 0.04 mmol/L (-0.03 to 0.12) for the high, moderate, low, and control conditions, respectively. The high-dose treatment produced significantly greater reductions in HbA1c and fasting blood glucose than the low-dose and control conditions (posterior probabilities (pp)<0.001); no other significant between-group differences were observed. Mean (CI) reductions in body weight were 10.91 kg (9.30 to 12.64), 10.08 kg (8.38 to 11.72), 6.35 kg (5.19 to 7.69), and 3.82 kg (3.04 to 4.54) for the high, moderate, low, and control conditions, respectively. All between-group differences in 6-month weight change were significant (pps<0.001) except for the high-dose versus moderate-dose comparison.
For adults with obesity and prediabetes a high dose of behavioral treatment involving 24 sessions over 6 months may be needed to optimize improvements in glycemic control.
NCT00912652.
本研究比较了三种剂量的行为减重治疗与营养教育对照组在肥胖和糖尿病前期患者血糖控制变化方面的差异。
本研究纳入了 287 名成年人（77%为女性，81%为白人；平均（SD）年龄=54.1（10.5）岁，体重指数=36.3（3.9）kg/m，糖化血红蛋白（HbA1c）=5.9（0.2%））。参与者被随机分配到三种行为治疗剂量组（高剂量=24 次，中剂量=16 次，低剂量=8 次）或教育组（对照组=8 次）。从基线到 6 个月评估 HbA1c、空腹血糖和体重的变化。
HbA1c 的平均（99.2%可信区间（CI））降低分别为 0.11%（0.07%至 0.16%）、0.08%（0.03%至 0.13%）、0.03%（-0.01%至 0.07%）和 0.02%（-0.02%至 0.07%），分别为高剂量、中剂量、低剂量和对照组。空腹血糖的平均（CI）降低分别为 0.26mmol/L（0.14 至 0.39）、0.09mmol/L（0 至 0.19）、0.01mmol/L（-0.07 至 0.09）和 0.04mmol/L（-0.03 至 0.12），分别为高剂量、中剂量、低剂量和对照组。高剂量治疗与低剂量和对照组相比，HbA1c 和空腹血糖的降低更为显著（后验概率（pp）<0.001）；未观察到其他显著的组间差异。体重的平均（CI）降低分别为 10.91kg（9.30 至 12.64）、10.08kg（8.38 至 11.72）、6.35kg（5.19 至 7.69）和 3.82kg（3.04 至 4.54），分别为高剂量、中剂量、低剂量和对照组。除高剂量与中剂量比较外，6 个月体重变化的所有组间差异均具有统计学意义（pp<0.001）。
对于肥胖和糖尿病前期的成年人，可能需要 24 次、为期 6 个月的高剂量行为治疗来优化血糖控制的改善。
NCT00912652。
