Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
BMJ Open Diabetes Res Care. 2023 May;11(3). doi: 10.1136/bmjdrc-2022-003179.
Intensive lifestyle intervention (ILI) has significantly reduced incidence of diabetes and improved many cardiovascular disease risk factors. We evaluated long-term effects of ILI on cardiometabolic risk factors, and microvascular and macrovascular complications among patients with diabetes in real-world clinical practice.
We evaluated 129 patients with diabetes and obesity enrolled in a 12-week translational model of ILI. At 1 year, we divided participants into group A, who maintained <7% weight loss (n=61, 47.7%), and group B, who maintained ≥7% weight loss (n=67, 52.3%). We continued to follow them for 10 years.
The total cohort lost an average of 10.8±4.6 kg (-9.7%) at 12 weeks and maintained an average weight loss of 7.7±10 kg (-6.9%) at 10 years. Group A maintained 4.3±9.5 kg (-4.3%) and group B maintained 10.8±9.3 kg (-9.3%) of weight loss at 10 years (p<0.001 between groups). In group A, A1c decreased from 7.5±1.3% to 6.7±0.9% at 12 weeks but rebounded to 7.7±1.4% at 1 year and 8.0±1.9% at 10 years. In group B, A1c decreased from 7.4±1.2% to 6.4±0.9% at 12 weeks then increased to 6.8±1.2% at 1 year and 7.3±1.5% at 10 years (p<0.05 between groups). Maintenance of ≥7% weight loss at 1 year was associated with a 68% lower risk of developing nephropathy for up to 10 years compared with maintenance of <7% weight loss (adjusted HR for group B: 0.32, 95% CI 0.11, 0.9, p=0.007).
Weight reduction in patients with diabetes can be maintained for up to 10 years in real-world clinical practice. Sustained weight loss is associated with significantly lower A1c at 10 years and improvement in lipid profile. Maintenance of ≥7% weight loss at 1 year is associated with decreased incidence of diabetic nephropathy at 10 years.
强化生活方式干预（ILI）显著降低了糖尿病的发病率，并改善了许多心血管疾病的风险因素。我们评估了 ILI 在真实临床实践中对糖尿病患者的心血管代谢危险因素以及微血管和大血管并发症的长期影响。
我们评估了 129 名患有糖尿病和肥胖症的患者，他们参加了为期 12 周的 ILI 转化模型。1 年后，我们将参与者分为 A 组（61 名，47.7%）和 B 组（67 名，52.3%），他们分别保持体重减轻<7%和≥7%。我们继续对他们进行了 10 年的随访。
整个队列在 12 周时平均减轻了 10.8±4.6 公斤（-9.7%），并在 10 年内平均保持了 7.7±10 公斤的体重减轻（-6.9%）。A 组在 10 年内保持了 4.3±9.5 公斤（-4.3%），B 组保持了 10.8±9.3 公斤（-9.3%）的体重减轻（组间差异<0.001）。在 A 组中，A1c 从 7.5±1.3%降至 12 周时的 6.7±0.9%，但在 1 年时反弹至 7.7±1.4%，在 10 年时升至 8.0±1.9%。在 B 组中，A1c 从 7.4±1.2%降至 12 周时的 6.4±0.9%，然后在 1 年时增加至 6.8±1.2%，在 10 年时增加至 7.3±1.5%（组间差异<0.05）。与保持体重减轻<7%相比，1 年内保持体重减轻≥7%与 10 年内发生肾病的风险降低 68%相关（B 组调整后的 HR：0.32，95%CI 0.11，0.9，p=0.007）。
在真实的临床实践中，糖尿病患者的体重减轻可以维持长达 10 年。持续的体重减轻与 10 年内 A1c 显著降低和血脂谱改善相关。1 年内保持体重减轻≥7%与 10 年内糖尿病肾病的发生率降低相关。
