一项为期15周的减肥计划（包括低热量配方饮食）对2型糖尿病合并超重或肥胖患者血糖控制的效果
Efficiency of a 15-Week Weight-Loss Program, Including a Low-Calorie Formula Diet, on Glycemic Control in Patients with Type 2 Diabetes Mellitus and Overweight or Obesity.
作者信息
Storck Lena J, Meffert Peter J, Rausch Janine, Gärtner Simone, Aghdassi Ali A, Kühn Jens-Peter, Kraft Matthias, Pietzner Maik, Lerch Markus M, Steveling Antje
机构信息
Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.
出版信息
Obes Facts. 2021 Feb 18;14(1):1-11. doi: 10.1159/000511453.
INTRODUCTION
Patients who are overweight or obese have an increased risk of developing type 2 diabetes mellitus (T2DM). Weight loss can have a positive effect on glycemic control.
OBJECTIVE
We aimed to investigate glycemic control in patients with T2DM and overweight or obesity during a structured weight-loss program.
METHODS
This was a prospective, interventional study. We recruited 36 patients (14 men and 22 women) with a median age of 58.5 years and median body mass index (BMI) of 34.1, to a 15-week structured weight-loss program with a low-calorie (800 kcal) formula diet for 6 weeks. The primary end point, HbA1c level, and secondary end points, anthropometric data, medication, and safety, were assessed weekly. Laboratory values and quality of life were assessed at baseline and after 15 weeks.
RESULTS
HbA1c decreased from 7.3% at baseline to 6.5% at 15 weeks (p < 0.001), median body weight by 11.9 kg (p < 0.001), median BMI by 4.3 (p < 0.001) and median waist circumference by 11.0 cm (p < 0.001). Two participants discontinued insulin therapy, 4 could reduce their dosage of oral antidiabetic agents, and 6 completely discontinued their antidiabetic medication. Insulin dose decreased from 0.63 (0.38-0.89) to 0.39 (0.15-0.70) units/kg body weight (p < 0.001). No patient experienced hypoglycemic episodes or hospital emergency visits. Triglycerides and total cholesterol decreased as well as surrogate markers of liver function. However, the levels of high-density and low-density lipoprotein cholesterol (HDL-C and LDL-C) as well as uric acid remain unchanged. Regarding quality of life, the median physical health score increased from 44.5 (39.7-51.4) at baseline to 48.0 (43.1-55.3; p = 0.007), and the median mental health score decreased from 42.1 (36.1-46.7) to 37.4 (30.3-43.7; p = 0.004).
CONCLUSIONS
A structured weight-loss program is effective in the short term in reducing HbA1c, weight, and antidiabetic medication in patients with T2DM who are overweight or obese. Levels of HDL-C and LDL-C were not affected by short-term weight loss. The decline in mental health and the long-term effects of improved glycemic control require further trials.
引言
超重或肥胖患者患2型糖尿病（T2DM）的风险增加。体重减轻对血糖控制有积极影响。
目的
我们旨在调查超重或肥胖的T2DM患者在结构化减肥计划期间的血糖控制情况。
方法
这是一项前瞻性干预研究。我们招募了36名患者（14名男性和22名女性），中位年龄为58.5岁，中位体重指数（BMI）为34.1，参加为期15周的结构化减肥计划，其中6周采用低热量（800千卡）配方饮食。每周评估主要终点糖化血红蛋白（HbA1c）水平以及次要终点人体测量数据、药物治疗和安全性。在基线和15周后评估实验室值和生活质量。
结果
HbA1c从基线时的7.3%降至15周时的6.5%（p<0.001），中位体重下降11.9千克（p<0.001），中位BMI下降4.3（p<0.001），中位腰围下降11.0厘米（p<0.001）。两名参与者停止胰岛素治疗，4名患者可减少口服降糖药剂量，6名患者完全停用降糖药。胰岛素剂量从0.63（0.38 - 0.89）降至0.39（0.15 - 0.70）单位/千克体重（p<0.001）。没有患者发生低血糖事件或前往医院急诊。甘油三酯和总胆固醇以及肝功能替代指标下降。然而，高密度和低密度脂蛋白胆固醇（HDL-C和LDL-C）水平以及尿酸保持不变。关于生活质量，中位身体健康评分从基线时的44.5（39.7 - 51.4）提高到48.0（43.1 - 55.3；p = 0.007），中位心理健康评分从42.1（36.1 - 46.7）降至37.4（30.3 - 43.7；p = 0.004）。
结论
结构化减肥计划在短期内对超重或肥胖的T2DM患者降低HbA1c、体重和降糖药物有效。短期体重减轻未影响HDL-C和LDL-C水平。心理健康的下降以及血糖控制改善的长期影响需要进一步试验。
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