Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sci Rep. 2024 Apr 5;14(1):8010. doi: 10.1038/s41598-024-58739-8.
Intensive lifestyle interventions are effective in preventing T2DM, but evidence is lacking for high cardiometabolic individuals in hospital settings. We evaluated a hospital-based, diabetes prevention program integrating cognitive behavioral therapy (CBT) for individuals with prediabetes. This matched cohort assessed individuals with prediabetes receiving the prevention program, which were matched 1:1 with those receiving standard care. The year-long program included five in-person sessions and several online sessions covering prediabetes self-management, dietary and behavioral interventions. Kaplan-Meier and Cox regression models estimated the 60-month T2DM incidence rate. Of 192 patients, 190 joined the prevention program, while 190 out of 10,260 individuals were in the standard-care group. Both groups had similar baseline characteristics (mean age 58.9 ± 10.2 years, FPG 102.3 ± 8.2 mg/dL, HbA1c 5.9 ± 0.3%, BMI 26.2 kg/m, metabolic syndrome 75%, and ASCVD 6.3%). After 12 months, the intervention group only showed significant decreases in FPG, HbA1c, and triglyceride levels and weight. At 60 months, the T2DM incidence rate was 1.7 (95% CI 0.9-2.8) in the intervention group and 3.5 (2.4-4.9) in the standard-care group. After adjusting for variables, the intervention group had a 0.46 times lower risk of developing diabetes. Therefore, healthcare providers should actively promote CBT-integrated, hospital-based diabetes prevention programs to halve diabetes progression.
强化生活方式干预可有效预防 T2DM，但在医院环境下针对高心血管代谢风险个体的证据尚缺乏。我们评估了一种基于医院的、针对糖尿病前期患者的预防计划，该计划整合了认知行为疗法（CBT）。该匹配队列评估了接受预防计划的糖尿病前期个体，并与接受标准护理的个体进行了 1:1 匹配。为期一年的计划包括五次面对面课程和几次在线课程，涵盖糖尿病前期自我管理、饮食和行为干预。Kaplan-Meier 和 Cox 回归模型估计了 60 个月的 T2DM 发病率。192 名患者中，有 190 名参加了预防计划，而标准护理组中有 190 名来自 10260 名个体。两组的基线特征相似（平均年龄 58.9±10.2 岁，FPG 102.3±8.2mg/dL，HbA1c 5.9±0.3%，BMI 26.2kg/m，代谢综合征 75%，ASCVD 6.3%）。12 个月后，干预组仅显示 FPG、HbA1c 和甘油三酯水平以及体重显著下降。60 个月时，干预组的 T2DM 发病率为 1.7（95%CI 0.9-2.8），标准护理组为 3.5（2.4-4.9）。调整变量后，干预组发生糖尿病的风险降低了 0.46 倍。因此，医疗保健提供者应积极推广 CBT 整合的、基于医院的糖尿病预防计划，以减半糖尿病的进展。
