Duhuze Karera M Grace, Wentzel Annemarie, Ishimwe M C Sage, Gatete Jean de Dieu, Jagannathan Ram, Horlyck-Romanovsky Margrethe F, Sumner Anne E
Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda.
Diabetes Metab Syndr Obes. 2023 Mar 9;16:677-692. doi: 10.2147/DMSO.S403054. eCollection 2023.
According to the International Diabetes Federation, sub-Saharan Africa is experiencing the highest anticipate increase in the prevalence of type 2 diabetes (T2D) in the world and has the highest percent of people living with T2D who are undiagnosed. Therefore, diagnosis and treatment need prioritization. However, pharmacological hypoglycemics are often unavailable and bariatric surgery is not an option. Therefore, the ability to induce T2D remission through lifestyle intervention alone (LSI-alone) needs assessment. This scoping review evaluated trials designed to induce T2D remission by LSI-alone. PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed to induce T2D remission through LSI-alone. Of the 928 identified, 63 duplicates were removed. With abstract review, 727 irrelevant articles were excluded. After full-text review, 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. These trials were published between 1984 and 2021 and were conducted in 10 countries, none of which were in Africa. Remission rates varied across trials. Predictors of remission were 10% weight loss and higher BMI, lower A1C and shorter T2D duration at enrollment. However, LSI-alone regimens for newly diagnosed and established T2D were very different. In newly diagnosed T2D, LSI-alone were relatively low-cost and focused on exercise and dietary counseling with or without calorie restriction (~1500 kcal/d). Presumably due to differences in cost, LSI-alone trials in newly diagnosed T2D had higher enrollments and longer duration. For established T2D trials, the focus was on arduous phased dietary interventions; phase 1: low-calorie meal replacement (<1000 kcal/day); phase 2: food re-introduction; phase 3: weight maintenance. In short, LSI-alone can induce remission in both newly diagnosed and established T2D. To demonstrate efficacy in Africa, initial trials could focus on newly diagnosed T2D. Insight gained could provide proof of concept and a foundation in Africa on which successful studies of LSI-alone in established T2D could be built.
根据国际糖尿病联合会的数据，撒哈拉以南非洲地区2型糖尿病（T2D）患病率的预计增幅在全球最高，且未被诊断出患有T2D的患者比例也最高。因此，诊断和治疗需要优先进行。然而，药物降糖药往往无法获得，减肥手术也不是一个选择。因此，需要评估仅通过生活方式干预（仅LSI）诱导T2D缓解的能力。本范围综述评估了旨在仅通过LSI诱导T2D缓解的试验。在PubMed、Embase、Cochrane和CINAHL数据库中搜索旨在仅通过LSI诱导T2D缓解的试验。在识别出的928项研究中，去除了63项重复研究。通过摘要审查，排除了727篇不相关的文章。经过全文审查，又去除了112篇不合适的文章。其余26篇文章描述了16项试验。这些试验发表于1984年至2021年之间，在10个国家进行，其中没有一个在非洲。各试验的缓解率各不相同。缓解的预测因素为体重减轻10%及更高的BMI、更低的糖化血红蛋白（A1C）以及入组时更短的T2D病程。然而，针对新诊断和已确诊T2D的仅LSI方案差异很大。对于新诊断的T2D，仅LSI相对成本较低，侧重于运动和饮食咨询，有或没有热量限制（约1500千卡/天）。可能由于成本差异，新诊断T2D的仅LSI试验入组人数更多，持续时间更长。对于已确诊T2D的试验，重点是严格的阶段性饮食干预；第1阶段：低热量代餐（<1000千卡/天）；第2阶段：重新引入食物；第3阶段：维持体重。简而言之，仅LSI可在新诊断和已确诊的T2D中诱导缓解。为了在非洲证明其疗效，初步试验可侧重于新诊断的T2D。获得的见解可为概念验证提供依据，并在非洲奠定基础，在此基础上可开展针对已确诊T2D的仅LSI的成功研究。
