Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Institute of Public Health, Cambridge, UK.
MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK.
Diabet Med. 2020 Apr;37(4):681-688. doi: 10.1111/dme.14122. Epub 2019 Sep 26.
To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up.
We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified via stepwise screening between 2002 and 2006, and underwent assessment of weight change, physical activity (EPAQ2 questionnaire), diet (plasma vitamin C and self-report), and alcohol consumption (self-report) at baseline and 1 year after diagnosis. Remission was examined at 5 years after diabetes diagnosis via HbA level. We constructed log binomial regression models to quantify the association between change in behaviour and weight over both the first year after diagnosis and the subsequent 1-5 years, as well as remission at 5-year follow-up.
Diabetes remission was achieved in 257 participants (30%) at 5-year follow-up. Compared with people who maintained the same weight, those who achieved ≥ 10% weight loss in the first year after diagnosis had a significantly higher likelihood of remission [risk ratio 1.77 (95% CI 1.32 to 2.38; p<0.01)]. In the subsequent 1-5 years, achieving ≥10% weight loss was also associated with remission [risk ratio 2.43 (95% CI 1.78 to 3.31); p<0.01].
In a population-based sample of adults with screen-detected Type 2 diabetes, weight loss of ≥10% early in the disease trajectory was associated with a doubling of the likelihood of remission at 5 years. This was achieved without intensive lifestyle interventions or extreme calorie restrictions. Greater attention should be paid to enabling people to achieve weight loss following diagnosis of Type 2 diabetes.
定量分析 2 型糖尿病诊断后行为改变与体重减轻之间的关系，以及 5 年随访时糖尿病缓解的可能性。
我们对来自 ADDITION-Cambridge 试验的 867 名年龄在 40-69 岁的新诊断为 2 型糖尿病的患者进行了前瞻性队列研究。参与者通过 2002 年至 2006 年的逐步筛查确定，并在诊断后 1 年和基线时评估体重变化、体力活动（EPAQ2 问卷）、饮食（血浆维生素 C 和自我报告）和饮酒（自我报告）。通过 HbA 水平检查 5 年后的糖尿病缓解情况。我们构建了对数二项式回归模型，以量化诊断后第一年和随后 1-5 年内行为和体重变化与 5 年随访时缓解之间的关系。
在 5 年随访时，257 名参与者（30%）实现了糖尿病缓解。与体重保持不变的人相比，在诊断后第一年体重减轻≥10%的人缓解的可能性显著更高[风险比 1.77（95%CI 1.32 至 2.38；p<0.01)]。在随后的 1-5 年内，体重减轻≥10%也与缓解相关[风险比 2.43（95%CI 1.78 至 3.31）；p<0.01)]。
在基于人群的 2 型糖尿病患者样本中，疾病早期体重减轻≥10%与 5 年时缓解的可能性增加一倍相关。这是在没有强化生活方式干预或极端热量限制的情况下实现的。应该更加关注在 2 型糖尿病诊断后帮助人们减轻体重。
