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JAMA:2型糖尿病强化生活方式干预对血糖控制影响如何?

2017-09-16 贾朝娟 环球医学

生活方式是2型糖尿病的重要干预之一。2017年8月,发表在《JAMA》的一项研究调查了强化生活方式干预对2型糖尿病患者血糖控制的影响。研究结果显示,生活方式干预与标准治疗相比,对血糖控制未达等效标准,但是有改善趋势。



生活方式是2型糖尿病的重要干预之一。2017年8月,发表在《JAMA》的一项研究调查了强化生活方式干预对2型糖尿病患者血糖控制的影响。研究结果显示,生活方式干预与标准治疗相比,对血糖控制未达等效标准,但是有改善趋势。

重要性:目前仍不清楚生活方式干预是否能使2型糖尿病患者维持血糖控制。

目的:考察同标准治疗相比,强化生活方式干预是否能起到相同的血糖控制作用;其次,是否能减少2型糖尿病患者降糖药物的使用。

设计、环境和受试者:于丹麦西兰大区和首都大区开展的一项随机、单盲、单中心研究(2015年4月~2016年8月)。纳入98名诊断时间<10年的非胰岛素治疗的2型糖尿病成年患者。患者被随机分配(2:1;根据性别分层)至生活方式组(n=64)或标准治疗组(n=34)。

干预:所有患者接受个体化咨询的标准治疗和标准化、盲法、目标导向的药物治疗。此外,生活干预包括5~6周有氧训练(周期30~60 min),其中有2~3次联合抗阻训练。生活方式组患者接受饮食计划,目的是控制体重指数为25或以下。随访12个月。

主要结局和测试指标:主要结局是基线至随访12个月时血红蛋白A1c(HbA1c)的变化,等效是基于意向治疗人群的置信区间±0.4%预先设定的。对次要结局开展优效性分析,即降糖药用量减少。

结果:在98名随机分配的受试者(平均年龄,54.6岁[SD,8.9];女性,47名[占48%];平均基线HbA1c,6.7%)中,93名受试者完成试验。从基线至随访12个月时,生活方式组的平均HbA1c水平从6.65%降至6.34%,标准治疗组从6.74%降至6.66%(变化的平均组间差异-0.26%[95%CI,-0.52%~-0.01%]),不符合等效标准(P=0.15)。生活方式组有47名受试者降糖药用量减少,标准治疗组有9名(26.45)(差值,47.1%[95%CI,28.6~65.3])。生活方式组有32例不良事件(最常见的是肌肉骨骼痛或不适和轻微低血糖),标准治疗组有5例。

结论和相关性:在2型糖尿病诊断时间<10年的成人中,生活方式干预与标准治疗相比,对血糖控制未达等效标准,但是有获益趋势。需要进一步研究评估优越性,以及可推广性和结果的持久性。

原始出处:

Johansen MY, et al. Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA. 2017 Aug 15;318(7):637-646. doi: 10.1001/jama.2017.10169.

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    2017-09-17 李东泽

    很好.学习了.很有帮助.

    0

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    2017-09-16 戒馋,懒,贪

    超厉害的说.谢谢分享

    0

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    2017-09-16 lovetcm

    这篇文章的特色是等效研究设计

    0

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    2017-09-16 lovetcm

    这么小的样本就能发JAMA

    0

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    2017-09-16 03101yly

    贴近生活.好文!

    0

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    2017-09-16 tanxingdoctor

    学习啦!谢谢分享!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1272963, encodeId=5de312e29636d, content=<a href='/topic/show?id=2f468983351' target=_blank style='color:#2F92EE;'>#血糖控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89833, encryptionId=2f468983351, topicName=血糖控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef84111, createdName=whlxd, createdTime=Sun Sep 17 15:03:00 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244827, encodeId=525524482e62, content=很好.学习了.很有帮助., beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sun Sep 17 00:23:30 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244541, encodeId=25fe24454123, content=超厉害的说.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=124, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Sat Sep 16 08:51:13 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244500, encodeId=d275244500e5, content=这篇文章的特色是等效研究设计, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Sep 16 07:00:10 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244496, encodeId=b8942444964d, content=这么小的样本就能发JAMA, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat Sep 16 06:59:27 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244469, encodeId=3b4e244469a9, content=贴近生活.好文!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/27/58c52c63ee4de8bf18f290e776b9d37d.jpg, createdBy=03552098449, createdName=03101yly, createdTime=Sat Sep 16 06:10:15 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244444, encodeId=0e2224444493, content=学习啦!谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLK1wzJZRTON4gxYUibhUyOypBwMibC4R7SsppicGhz5Ogoy0VVq4CWnqaD2Moeib8RWxI5lOiaVmnxpan/0, createdBy=c53f1730331, createdName=tanxingdoctor, createdTime=Sat Sep 16 00:15:26 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244436, encodeId=9704244436a5, content=学习了很有用不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sat Sep 16 00:11:18 CST 2017, time=2017-09-16, status=1, ipAttribution=)]
    2017-09-16 飛歌

    学习了很有用不错

    0

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