Lingnan Statistical Science Research Institute, Guangzhou University, Guangzhou, China.
Da'an Yifukang Specialist Outpatient Department, Guangdong Shengke Life and Health Technology Limited Company, Guangzhou, China.
Ann Palliat Med. 2022 Apr;11(4):1462-1472. doi: 10.21037/apm-22-369.
Whether diabetes remission still happened among non-obese type 2 diabetes (T2DM) patients with a body mass index (BMI) <25 kg/m2 following lifestyle-medicine interventions was quite necessary to be reported because many diabetes happened with normal or low BMI in China.
The criteria for subject inclusion: <20 years after T2DM diagnosis, ≥6 months treatment with oral anti-diabetic drugs, without serious complications, and no history of insulin use. They were divided into two groups: the obesity group (BMI ≥25 kg/m2) and the lean group (BMI <25 kg/m2). All subjects received the following lifestyle-medicine interventions: stopping oral anti-diabetic therapy, initiating a low-carbohydrate (contributing by 35-40% to calorie intake) diet for the first month (gradual transition to a normal diet for the next 5 months), participating in resistance and aerobic exercise, and receiving strengthen management. Diabetes remission was defined as glycosylated hemoglobin (A1C) level <6.5% (<48 mmol/mol) after 6 months of not taking any anti-diabetic medications during the lifestyle-medicine intervention. Finally, 125 individuals completed the lifestyle-medicine intervention in the prospective study. The efficacy and safety of lifestyle-medicine intervention were assessed and compared between lean and obese Chinese subjects with T2DM.
We found that 64.52% of the T2DM subjects in the obese group and 60.64% of T2DM subjects in the lean group achieved diabetes remission [i.e., an A1C level <6.5% (48 mmol/mol)] without any anti-diabetic medications after the 6-month lifestyle-medicine intervention. Our multiple linear regression analysis showed that decreases in the fasting plasma glucose (FPG) level had the most powerful effect on decreases in the A1C level after the intervention (R2=0.3072).
Lifestyle-medicine interventions may have increased effectiveness in controlling mild T2DM as compared with the oral antidiabetic-based treatment; unexpectedly, there seems no further improvement in lean relative to obese patients. Three in five subjects could achieve diabetes remission though the lifestyle-medicine intervention regardless of whether their BMI was below or above 25 kg/m2.
在中国，许多糖尿病患者的 BMI 正常或偏低，因此，有必要报告非肥胖 2 型糖尿病（T2DM）患者在生活方式医学干预后，BMI＜25kg/m2 时糖尿病缓解是否仍然发生。
纳入标准：T2DM 诊断后＜20 年，口服降糖药治疗≥6 个月，无严重并发症，无胰岛素使用史。他们被分为两组：肥胖组（BMI≥25kg/m2）和消瘦组（BMI＜25kg/m2）。所有患者均接受以下生活方式医学干预：停止口服降糖治疗，第 1 个月采用低碳水化合物（占热量摄入 35-40%）饮食（接下来 5 个月逐渐过渡到正常饮食），进行抗阻运动和有氧运动，并接受强化管理。糖尿病缓解定义为生活方式医学干预 6 个月内不服用任何降糖药物时糖化血红蛋白（A1C）水平＜6.5%（＜48mmol/mol）。最后，125 名患者完成了前瞻性研究中的生活方式医学干预。评估并比较了生活方式医学干预对中国肥胖和消瘦 T2DM 患者的疗效和安全性。
我们发现，肥胖组 64.52%的 T2DM 患者和消瘦组 60.64%的 T2DM 患者在 6 个月的生活方式医学干预后无需任何降糖药物即可达到糖尿病缓解（即 A1C＜6.5%（＜48mmol/mol））。我们的多元线性回归分析表明，干预后 FPG 水平的降低对 A1C 水平的降低影响最大（R2=0.3072）。
与基于口服降糖药的治疗相比，生活方式医学干预可能对控制轻度 T2DM 更有效；出乎意料的是，与肥胖患者相比，消瘦患者似乎没有进一步改善。无论 BMI 是否低于或高于 25kg/m2，通过生活方式医学干预，大约有三分之二的患者可以达到糖尿病缓解。
