Uusitupa M I
Department of Clinical Nutrition, University of Kuopio, Finland.
Ann Med. 1996 Oct;28(5):445-9. doi: 10.3109/07853899608999106.
Non-insulin-dependent diabetes mellitus (NIDDM) is preceded by impaired glucose tolerance (IGT) lasting for years before manifesting as overt hyperglycaemia. Both genetic and environmental factors contribute to the development of IGT and NIDDM. Obesity, physical inactivity and high-fat diet have been found to predict IGT and NIDDM. Therefore, a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM. Furthermore, because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular disease, it is reasonable to assume that in terms of reducing the incidence and longterm consequences of NIDDM an intervention at this phase is more effective than in overt diabetes. Although the nonpharmacological approach is generally accepted as the first-line treatment of NIDDM its efficacy has often been questioned. Therefore, it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM. This kind of study also gave relevant experience in planning studies aiming at primary prevention of NIDDM. One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio, Finland resulted in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group. After the second year of follow-up only 12.5% in the intervention group were receiving oral antidiabetic drugs vs. 34.8% in the conventional treatment group. Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results. Good aerobic capacity was associated with an increase in HDL cholesterol. A multicentre primary prevention study on IGT patients is continuing in Finland applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients. Pilot results show that glucose tolerance can be improved by lifestyle changes.
非胰岛素依赖型糖尿病（NIDDM）之前会有持续数年的糖耐量受损（IGT），之后才会表现为明显的高血糖。遗传和环境因素都对IGT和NIDDM的发展有影响。已发现肥胖、缺乏体育活动和高脂饮食可预测IGT和NIDDM。因此，从NIDDM诊断开始进行饮食和运动干预可改善NIDDM患者的治疗效果和预后。此外，由于IGT患者患糖尿病和动脉粥样硬化性血管疾病的风险增加，因此可以合理地假设，就降低NIDDM的发病率和长期后果而言，在此阶段进行干预比在显性糖尿病阶段更有效。尽管非药物方法通常被认为是NIDDM的一线治疗方法，但其疗效常常受到质疑。因此，开展长期对照研究以确定生活方式改变在多大程度上可以改善代谢控制以及已知与NIDDM不良结局相关的主要心血管危险因素水平非常重要。这类研究还为旨在对NIDDM进行一级预防的研究规划提供了相关经验。对芬兰库奥皮奥新诊断的NIDDM患者进行的为期一年的饮食和运动干预与传统治疗组相比，代谢控制更好，心血管危险因素适度降低。随访第二年结束时，干预组只有12.5%的患者在接受口服抗糖尿病药物治疗，而传统治疗组为34.8%。体重减轻和饱和脂肪摄入量减少似乎是治疗成功的主要决定因素。良好的有氧能力与高密度脂蛋白胆固醇升高有关。芬兰正在对IGT患者进行一项多中心一级预防研究，采用与新诊断的NIDDM患者研究相同的干预原则。初步结果表明，生活方式改变可改善糖耐量。
