Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA
Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
BMJ Open Diabetes Res Care. 2022 Mar;10(2). doi: 10.1136/bmjdrc-2021-002748.
In studies that enrolled people with prevalent pre-diabetes of unknown duration, lifestyle intervention (LI) delayed progression to type 2 diabetes (T2D) but did not reverse pre-diabetes in most participants. Here, we assessed the effects of LI among individuals with pre-diabetes of known duration to determine whether outcomes are related to duration of pre-diabetes.
The Pathobiology and Reversibility of Prediabetes in a Biracial Cohort study initiated LI in subjects with incident pre-diabetes during follow-up of initially normoglycemic African Americans and European Americans with parental T2D. Participants were stratified into those initiating LI after <3, 3-5, or >5 years of pre-diabetes diagnosis. Assessments included anthropometry, body fat, fasting and 2-hour plasma glucose (FPG, 2hPG), and insulin sensitivity and secretion. The outcomes were normal glucose regulation (NGR; ie, normal FPG and 2hPG), persistent pre-diabetes, or T2D. Participants who maintained normal FPG and normal 2hPG levels during follow-up served as the control. The control subjects did not receive lifestyle or other intervention to alter the course of glycemia or body weight.
Of 223 participants (age 53.3±9.28 years, body mass index 30.6±6.70 kg/m), 72 (control) maintained normoglycemia during follow-up and 138 subjects with incident pre-diabetes initiated LI after 4.08±2.02 years (range 3 months-8.3 years) of diagnosis. Compared with control, LI participants showed decrease in glucose, weight, and body fat; 42.8% reverted to NGR, 50% had persistent pre-diabetes, and 7.2% developed T2D after 5 years. These outcomes were similar across race and pre-diabetes duration strata, but greater glycemic decrease occurred when LI was initiated within 5 years of pre-diabetes diagnosis.
Ninety-three per cent of adults with parental T2D who initiated LI within 3 months to 8.3 years of developing pre-diabetes did not progress to T2D; nearly half reverted to NGR. NCT02027571.
在研究中，纳入了患有未知持续时间的前期糖尿病的人群，生活方式干预（LI）延迟了 2 型糖尿病（T2D）的进展，但未能使大多数参与者的前期糖尿病逆转。在这里，我们评估了已知持续时间的前期糖尿病患者的 LI 效果，以确定结果是否与前期糖尿病的持续时间有关。
在一项具有双种族队列的研究中，当最初血糖正常的非洲裔美国人和欧洲裔美国人的父母患有 2 型糖尿病时，对新发生前期糖尿病的参与者启动 LI。参与者根据前期糖尿病诊断后<3、3-5 或>5 年的时间进行分层，以启动 LI。评估包括人体测量学、体脂肪、空腹和 2 小时血糖（FPG、2hPG）以及胰岛素敏感性和分泌。结果为正常血糖调节（NGR；即，正常 FPG 和 2hPG）、持续前期糖尿病或 T2D。在随访期间保持正常 FPG 和正常 2hPG 水平的参与者作为对照组。对照组未接受生活方式或其他干预措施来改变血糖或体重的进程。
在 223 名参与者（年龄 53.3±9.28 岁，体重指数 30.6±6.70kg/m）中，72 名（对照组）在随访期间保持血糖正常，138 名新诊断为前期糖尿病的患者在诊断后 4.08±2.02 年后（范围 3 个月至 8.3 年）开始接受 LI。与对照组相比，LI 参与者的血糖、体重和体脂肪均有所下降；42.8%的人恢复到 NGR，50%的人持续存在前期糖尿病，7.2%的人在 5 年后发展为 T2D。这些结果在种族和前期糖尿病持续时间分层中相似，但在前期糖尿病诊断后 5 年内开始 LI 时，血糖下降幅度更大。
在父母患有 2 型糖尿病的成年人中，93%的人在诊断出前期糖尿病后 3 个月至 8.3 年内开始接受 LI，他们没有进展为 T2D；近一半的人恢复到 NGR。NCT02027571。
