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强化生活方式干预对2型糖尿病患者的心血管事件的影响
Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes


The Look AHEAD Research Group* 糖尿病 • 2013.07.11
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摘要


背景

基于短期研究的结果,超重或肥胖的2型糖尿病患者(T2DM)被建议减轻体重,但减重对心血管系统的长期影响尚不清楚。本研究旨在探讨以减重为目的的强化生活方式干预,是否可以降低上述患者的心血管事件的发病率和死亡率。

 

方法

本研究在美国16个研究中心开展,共纳入5,145例超重或肥胖的T2DM患者,患者被随机分为两组:接受强化生活方式干预,通过减少热量摄取及增加体力活动来促进减重(干预组);或者参加糖尿病相关支持和教育咨询(对照组)。主要结局为在最长13.5年的随访时间内的心血管原因的死亡、非致死性心肌梗死、非致死性卒中或因心绞痛所致住院的复合终点。

 

结果

本研究于中位随访时间9.6年时,因判断干预无效而提前终止。研究终点结果提示:在整个研究过程中,干预组体重减轻程度始终较对照组明显(随访1年时:8.6%对0.7%;研究终止:6.0%对3.5%)。强化生活方式干预组糖化血红蛋白降低、前期的体能增强及除低密度脂蛋白胆固醇外的所有心血管危险因素的改善都更为显著。干预组和对照组分别有403例和418例患者出现了主要终点事件,(发生率分别为1.83和1.92次事件/100人年,干预组的风险比为0.95,95%可信区间[CI]为0.83~1.09,P=0.51)。

 

结论

以减重为目的的强化生活方式干预,未能降低超重或肥胖的T2DM患者的心血管事件发生率(本研究由美国国家卫生研究院[National Institutes of Health]等资助,Look AHEAD研究在ClinicalTrials.gov注册号为NCT00017953)。





作者信息

The Look AHEAD Research Group*
The authors and their affiliations are listed in the Appendix. Address reprint requests to Dr. Rena Wing at the Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University and Miriam Hospital, 196 Richmond St., Providence, RI 02903, or at rwing@lifespan.org. *A complete list of participants in the Look AHEAD (Action for Health in Diabetes) Research Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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