运动对 2 型糖尿病降糖药物的剂量-反应效应：一项随机临床试验的二次分析。

Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial.

机构信息

Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; CopenRehab, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

出版信息

Mayo Clin Proc. 2020 Mar;95(3):488-503. doi: 10.1016/j.mayocp.2019.09.005. Epub 2020 Jan 30.

DOI:10.1016/j.mayocp.2019.09.005

PMID:32007295

Abstract

OBJECTIVE

To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes.

PATIENTS AND METHODS

Secondary analyses of a randomized controlled exercise-based lifestyle intervention trial (April 29, 2015 to August 17, 2016). Patients with non-insulin-dependent type 2 diabetes were randomly assigned to an intensive lifestyle intervention (U-TURN) or standard-care group. Both groups received lifestyle advice and objective target-driven medical regulation. Additionally, the U-TURN group received supervised exercise and individualized dietary counseling. Of the 98 randomly assigned participants, 92 were included in the analysis (U-TURN, n=61, standard care, n=31). Participants in the U-TURN group were stratified into tertiles based on accumulated volumes of exercise completed during the 1-year intervention.

RESULTS

Median exercise levels of 178 (interquartile range [IQR], 121-213; lower tertile), 296 (IQR, 261-310; intermediate tertile), and 380 minutes per week (IQR, 355-446; upper tertile) were associated with higher odds of discontinuing treatment with glucose-lowering medication, with corresponding odds ratios of 12.1 (95% CI, 1.2-119; number needed to treat: 4), 30.2 (95% CI, 2.9-318.5; 3), and 34.4 (95% CI, 4.1-290.1; 2), respectively, when comparing with standard care. Cardiovascular risk factors such as glycated hemoglobin A levels, fitness, 2-hour glucose levels, and triglyceride levels were improved significantly in the intermediate and upper tertiles, but not the lower tertile, compared with the standard-care group.

CONCLUSION

Exercise volume is associated with discontinuation of glucose-lowering medication treatment in a dose-dependent manner, as are important cardiovascular risk factors in well-treated participants with type 2 diabetes and disease duration less than 10 years. Further studies are needed to support these findings.

STUDY REGISTRATION

ClinicalTrials.gov registration (NCT02417012).

摘要

目的

探讨 2 型糖尿病患者运动量与降糖药物治疗停药之间是否存在剂量反应关系。

患者和方法

这是一项基于随机对照运动的生活方式干预试验（2015 年 4 月 29 日至 2016 年 8 月 17 日）的二次分析。非胰岛素依赖型 2 型糖尿病患者被随机分配到强化生活方式干预（U-TURN）或标准护理组。两组均接受生活方式建议和客观目标驱动的医学调节。此外，U-TURN 组还接受了监督运动和个体化饮食咨询。在 98 名随机分配的参与者中，有 92 名被纳入分析（U-TURN 组，n=61；标准护理组，n=31）。U-TURN 组的参与者根据 1 年干预期间完成的累积运动量分为三分位组。

结果

中位运动水平为 178 分钟（四分位距 [IQR]，121-213；低三分位）、296 分钟（IQR，261-310；中三分位）和 380 分钟/周（IQR，355-446；高三分位）与更高的停用降糖药物治疗的几率相关，相应的比值比为 12.1（95%可信区间，1.2-119；需要治疗的人数：4）、30.2（95%可信区间，2.9-318.5；3）和 34.4（95%可信区间，4.1-290.1；2），与标准护理相比。在中间和高三分位组，与标准护理组相比，心血管危险因素如糖化血红蛋白 A 水平、体能、2 小时血糖水平和甘油三酯水平显著改善，但低三分位组没有改善。