National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK.
Centre for Exercise Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
Diabet Med. 2020 Apr;37(4):564-572. doi: 10.1111/dme.14217. Epub 2020 Jan 13.
To review evidence on whether diet and exercise should be used as an alternative to drug therapy for the management of type 2 diabetes or alongside.
We present a narrative review that draws on evidence from other systematic reviews and meta-analyses, narrative reviews, trials and cohort studies. We focused mainly on glycaemic control rather than control of blood pressure or cholesterol.
Good-quality dietary advice that results in weight loss of >5% and physical activity interventions of >150 min/week of moderate to vigorous physical activity, combined with resistance exercise, can produce improvements in HbA similar to those produced by the addition of glucose-lowering drugs. These improvements can be seen at all stages of the disease. There are recognized interactions between glucose-lowering drugs and physical activity which may not be synergistic, but these are not well understood, and it is not clear if they are considered in clinical practice. Studies that explicitly compare drugs with diet or physical activity or control for drug use found that lifestyle could delay or reduce medication use, but most people eventually needed to progress to drug treatment. There are few studies, however, that provide strategies for the long-term maintenance of weight loss or physical activity.
Diet and physical activity are of key importance in type 2 diabetes management, and attention to them improves glycaemic control and cardiovascular disease risk, but it is not yet known whether maintained lifestyle changes provide an alternative to drug therapy in the long term.
回顾关于饮食和运动是否应作为 2 型糖尿病管理的药物治疗替代方案或联合方案的证据。
我们进行了叙述性综述，借鉴了其他系统评价和荟萃分析、叙述性综述、试验和队列研究的证据。我们主要关注血糖控制，而不是血压或胆固醇控制。
高质量的饮食建议可导致体重减轻>5%，并进行>150 分钟/周的中等至剧烈体力活动的身体活动干预，结合抗阻运动，可以使 HbA 得到与添加降血糖药物相似的改善。这些改善可以在疾病的所有阶段看到。已经认识到降血糖药物和身体活动之间存在相互作用，这些相互作用可能不是协同的，但这些相互作用尚未得到很好的理解，也不清楚它们是否在临床实践中得到考虑。明确比较药物与饮食或身体活动或控制药物使用的研究发现，生活方式可以延缓或减少药物使用，但大多数人最终需要进展到药物治疗。然而，很少有研究提供长期维持体重减轻或身体活动的策略。
饮食和身体活动在 2 型糖尿病管理中至关重要，对其的关注可以改善血糖控制和心血管疾病风险，但目前尚不清楚长期维持的生活方式改变是否可以替代药物治疗。
