Lucas C P, Patton S, Stepke T, Kinhal V, Darga L L, Carroll-Michals L, Spafford T R, Kasim S
Am J Med. 1987 Sep 18;83(3A):3-9. doi: 10.1016/0002-9343(87)90797-2.
Non-insulin-dependent diabetes mellitus (NIDDM) is the most common form of diabetes in the civilized world. Its consequences include microvascular and macrovascular disease, both of which appear to evolve from a common background of obesity and physical inactivity. The current study was undertaken in obese patients with NIDDM to see whether improvements could be made in glycemic control as well as in many cardiovascular risk factors (obesity, hypertension, lipid abnormalities, and physical inactivity) that are typical of this condition. Fifteen obese insulin-using patients with NIDDM (average body mass index, 34.0) were treated with a 500-calorie formula diet for eight to 12 weeks. Administration of insulin and diuretics was discontinued at the onset of the study. A eucaloric diet was begun at eight to 12 weeks and maintained until Week 24. A behaviorally oriented nutrition-exercise program was instituted at the beginning of the study. Glipizide or placebo was added (randomized) at Week 15 if the fasting plasma glucose level in patients exceeded 115 mg/dl. Patients lost an average of 22 pounds over the course of 24 weeks. Frequency and duration of physical activity increased significantly from baseline, as did the maximal oxygen consumption rate. Glycemic control by 15 weeks (without insulin) was similar to baseline (with insulin). With the addition of glipizide at Week 15, both fasting plasma glucose and glucose tolerance improved significantly. This improvement was not observed with placebo. In addition, both systolic and diastolic blood pressure decreased by about 10 mm Hg. There were no significant changes in the levels of serum lipids or glycosylated hemoglobin. In conclusion, a multifaceted intervention program, employing weight reduction, exercise, diet, and glipizide therapy, can be instituted in insulin-using patients with NIDDM, with improvement in glycemic control and in certain risk factors (hypertension, obesity, physical inactivity) for cardiovascular disease.
非胰岛素依赖型糖尿病（NIDDM）是文明世界中最常见的糖尿病形式。其后果包括微血管和大血管疾病，这两种疾病似乎都源于肥胖和缺乏身体活动的共同背景。本研究针对肥胖的NIDDM患者进行，旨在观察血糖控制以及该疾病典型的许多心血管危险因素（肥胖、高血压、血脂异常和缺乏身体活动）是否能够得到改善。15名使用胰岛素的肥胖NIDDM患者（平均体重指数为34.0）接受了为期8至12周的500卡路里配方饮食治疗。研究开始时停用胰岛素和利尿剂。在8至12周开始给予等热量饮食，并维持至第24周。在研究开始时制定了以行为为导向的营养 - 运动计划。如果患者的空腹血糖水平超过115 mg/dl，则在第15周添加格列吡嗪或安慰剂（随机分组）。患者在24周内平均减重22磅。身体活动的频率和持续时间从基线显著增加，最大耗氧率也是如此。15周时（不使用胰岛素）的血糖控制与基线（使用胰岛素）相似。在第15周添加格列吡嗪后，空腹血糖和糖耐量均显著改善。安慰剂组未观察到这种改善。此外，收缩压和舒张压均下降约10 mmHg。血脂水平和糖化血红蛋白水平无显著变化。总之，对于使用胰岛素的NIDDM患者，可以实施包括减重、运动、饮食和格列吡嗪治疗的多方面干预计划，以改善血糖控制以及某些心血管疾病危险因素（高血压、肥胖、缺乏身体活动）。
