Munshi Medha N, Venditti Elizabeth M, Tjaden Ashley H, Knowler William C, Boyko Edward J, Middelbeek Roeland J W, Luchsinger José A, Lee Christine G, Hazuda Helen P, Salive Marcel E, Edelstein Sharon L, Storer Thomas W
Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Front Public Health. 2024 Dec 18;12:1470035. doi: 10.3389/fpubh.2024.1470035. eCollection 2024.
Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. We aimed to examine the long-term effects of metformin or intensive lifestyle intervention in adults at high risk of T2D on their 6-min walk test (6MWT) performance.
Participants were randomized in the 3-year Diabetes Prevention Program (DPP) to one of the three groups: lifestyle intervention, metformin, or placebo, and were subsequently followed in the DPP Outcomes Study. A 6MWT was conducted 20 years after randomization. Associations between DPP interventions and 6MWT completion (achieving a distance ≥200 m) were assessed using logistic regression. Among the test completers, differences in distance walked (6MWD) were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of body mass index (BMI) and grip strength along with mean measures of HbA1c and self-reported physical activity (PA).
Data on 1830 participants were analyzed. The interventions were not associated with test completion or the 6MWD among test completers (362, 364, and 360 m in the lifestyle, metformin, and placebo groups, respectively, = 0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and the 6MWD after adjustment. Grip strength, PA, and education were positively associated with the 6MWD, while age, BMI, and HbA1c were negatively associated with the 6MWD.
We confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle. However, we did not observe a sustained effect of the original randomized interventions.
http://www.clinicaltrials.gov/ct/show/NCT00004992, identifier DPP NCT00004992; http://www.clinicaltrials.gov/ct/show/NCT00038727, identifier DPPOS NCT00038727.
2型糖尿病（T2D）和糖尿病前期与步行耐力差有关，步行耐力是身体功能的一个指标。我们旨在研究二甲双胍或强化生活方式干预对T2D高危成年人6分钟步行试验（6MWT）表现的长期影响。
参与者在为期3年的糖尿病预防计划（DPP）中被随机分为三组之一：生活方式干预组、二甲双胍组或安慰剂组，随后在DPP结局研究中进行随访。随机分组20年后进行6MWT。使用逻辑回归评估DPP干预与6MWT完成情况（行走距离≥200米）之间的关联。在试验完成者中，使用多变量线性回归评估行走距离（6MWD）的差异。其他感兴趣的变量包括体重指数（BMI）和握力的伴随测量，以及糖化血红蛋白（HbA1c）的平均测量值和自我报告的身体活动（PA）。
对1830名参与者的数据进行了分析。干预措施与试验完成情况或试验完成者的6MWD无关（生活方式干预组、二甲双胍组和安慰剂组的6MWD分别为362米、364米和360米，P = 0.8）。调整后，年龄、教育程度、握力和PA均与6MWT完成情况和6MWD显著相关。握力、PA和教育程度与6MWD呈正相关，而年龄、BMI和HbA1c与6MWD呈负相关。
我们证实，6MWT与T2D高危人群和T2D患者的其他身体能力指标如PA和握力有关，这表明保持健康生活方式可能具有长期益处。然而，我们没有观察到原始随机干预措施的持续效果。
http://www.clinicaltrials.gov/ct/show/NCT00004992，标识符DPP NCT00004992；http://www.clinicaltrials.gov/ct/show/NCT00038727，标识符DPPOS NCT00038727。
