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成人肥胖2型糖尿病患者的生活方式改变与运动功能
Lifestyle Change and Mobility in Obese Adults with Type 2 Diabetes


W. Jack Rejeski ... 糖尿病 • 2012.03.29
相关阅读
• 2型糖尿病的门诊和住院治疗 • 1型和2型糖尿病患者的死亡率和心血管疾病结局

摘要


背景

2型糖尿病成年患者随着年龄的增长其运动功能往往会下降。在这些患者中,强化的生活方式干预可促使体重减轻,身体素质提高,进而减缓运动功能的丧失。


方法

我们随机选取了5,145名年龄在45~74岁患有糖尿病的超重或肥胖的成年人,一部分进行强化生活方式干预,另一部分加入糖尿病支持和教育计划;最终获得5,016名参与者的数据。我们采用“隐马尔科夫模型”分析失能状态,用混合效应的有序逻辑斯谛回归评估功能减退的可能性。在4年中每年进行一次评估,主要结局是患者自述的运动受限。


结果

到第4年,生活方式干预组的2,514名成人中,517名(20.6%)参与者有严重运动失能,969名(38.5%)参与者运动功能良好;而在支持组的2,502名参与者中,数据分别是656名(26.2%)和798名(31.9%)。与支持组(风险比:0.52;95%可信区间:0.44~0.63;P<0.001)相比,生活方式干预组使运动失能风险降低48%。体重减轻和身体素质提高(通过平板运动实验评估)是产生这一结果的重要原因(两个变量均P<0.001)。与生活方式干预相关的不良事件包括在第一年出现频率稍高的骨骼肌肉症状。


结论

患有2型糖尿病的超重成人中,体重减轻和体质改善可减缓运动功能的下降(卫生和人类服务部[Department of Health and Human Services]等资助;ClinicalTrials.gov注册号为NCT00017953)。





作者信息

W. Jack Rejeski, Ph.D., Edward H. Ip, Ph.D., Alain G. Bertoni, M.D., George A. Bray, M.D., Gina Evans, Ph.D., Edward W. Gregg, Ph.D., and Qiang Zhang, M.S., for the Look AHEAD Research Group *
From the Reynolda Campus (W.J.R.) and the School of Medicine (E.H.I., A.G.B., Q.Z.), Wake Forest University, Winston-Salem, NC; the Pennington Biomedical Research Center, Louisiana State University, Baton Rouge (G.A.B.); Baylor College of Medicine, Houston (G.E.); and the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (E.W.G.). Address reprint requests to Dr. Rejeski at Wake Forest University, Department of Health and Exercise Sciences, Box 7868, Winston-Salem, NC 27109, or at rejeski@wfu.edu. *Investigators in the Look AHEAD (Action for Health in Diabetes) Research Group are listed in the Supplementary Appendix, available at NEJM.org.

 

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