School of Public Health-Bloomington, Department of Applied Health Science, Indiana University, Bloomington, IN, USA.
Division of Biostatistics, School of Public Health, Ohio State University, Columbus, OH, USA.
Transl Behav Med. 2024 May 24;14(6):368-376. doi: 10.1093/tbm/ibad077.
Early slow weight loss during treatment is associated with less weight loss overall. The impact of an augmented intervention designed for early slow weight loss responders compared with a standard diabetes prevention intervention was evaluated following 12 months of treatment and 6 months of no contact. The impact of standard vs. augmented intervention sequences on weight and glycemia also was determined. Adults were ≥21 years old with overweight or obesity and prediabetes (n = 174). Slow responders were stratified to augmented treatment if they failed to achieve >2.5% weight loss (%WL) at Week 5. Matched within-sex pairs of participants were created based on %WL at Month 5 following the intensive intervention phase, and each person within the pair was randomly assigned to treatment for Months 5-12 during the extended intervention phase. Both 12-month interventions included a ≥7%WL goal. Mean 12-month %WL was 5.29% (95% CI: 4.27%-6.31%; P < .0001) and 18-month %WL was 3.34% (95% CI: 2.01%-4.66%; P < .0001) overall. %WL was greater for the standard (9.55%) than the augmented (4.0%) intervention (P = .0001); no differences occurred in weight regain between early and slow responders (P = .9476). No differences occurred in mean %WL at 12 months between the standard and augmented groups after controlling for %WL at Week 5 and sex (P = .23) nor in the change in glycemia (all P > .05). WL following the first month of treatment predicted 12- and 18-month WL success regardless of intervention sequence; however, even early slow responders achieved significant WL during treatment. Further research is needed to support effective WL maintenance for people with prediabetes.
治疗早期体重缓慢下降与整体减重较少有关。评估了针对早期体重缓慢下降反应者设计的增强干预措施与标准糖尿病预防干预措施相比在治疗 12 个月和 6 个月无接触后的效果。还确定了标准与增强干预序列对体重和血糖的影响。参与者为年龄≥21 岁、超重或肥胖且患有前驱糖尿病的成年人（n = 174）。如果在第 5 周体重下降未超过 2.5%（%WL），则将缓慢反应者分层为增强治疗。根据强化干预阶段结束后第 5 个月的%WL，对参与者进行性别匹配，每对参与者中的每个人在扩展干预阶段的第 5-12 个月期间被随机分配至治疗。这两种 12 个月的干预均包括≥7%WL 的目标。平均 12 个月的%WL 为 5.29%（95%CI：4.27%-6.31%；P <.0001），18 个月的%WL 为 3.34%（95%CI：2.01%-4.66%；P <.0001）。标准（9.55%）干预的%WL 高于增强（4.0%）干预（P =.0001）；早期和缓慢反应者之间在体重恢复方面没有差异（P =.9476）。在控制第 5 周的%WL 和性别后，标准组和增强组在 12 个月时的平均%WL 没有差异（P =.23），血糖变化也没有差异（所有 P >.05）。治疗第一个月后的 WL 无论干预序列如何，均可预测 12 个月和 18 个月的 WL 成功；然而，即使是早期的缓慢反应者在治疗期间也实现了显著的 WL。需要进一步的研究来支持前驱糖尿病患者的有效 WL 维持。
