期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 308, 期 23, 页码 2489-2496出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2012.67929
关键词
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资金
- US Department of Health and Human Services from the National Institutes of Health (NIH) [DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992]
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Heart, Lung, and Blood Institute
- National Institute of Nursing Research
- National Center on Minority Health and Health Disparities
- NIH Office of Research on Women's Health
- Centers for Disease Control and Prevention
- Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service (IHS)
- Johns Hopkins Medical Institutions Bayview General Clinical Research Center [M01RR02719]
- Massachusetts General Hospital Mallinckrodt General Clinical Research Center
- Massachusetts Institute of Technology General Clinical Research Center [M01RR01066]
- University of Colorado Health Sciences Center General Clinical Research Center [M01RR00051]
- Clinical Nutrition Research Unit [P30 DK48520]
- University of Tennessee at Memphis General Clinical Research Center [M01RR0021140]
- University of Pittsburgh General Clinical Research Center [M01RR000056]
- Clinical Translational Research Center
- Clinical and Translational Science Award [UL1 RR 024153]
- NIH [DK 046204]
- VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs
- Frederic C. Bartter General Clinical Research Center [M01RR01346]
Context The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear. Objective To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia. Design, Setting, and Participants Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes. Interventions Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262). Main Outcome Measures Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A(1c) <6.5% with no antihyperglycemic medication). Results Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, -7.9%; 95% CI, -8.3% to -7.6%) and at year 4 (-3.9%; 95% CI, -4.4% to -3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P<.001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%-12.8%) during the first year and 7.3% (95% CI, 6.2%-8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%-2.6% at year 1 and 1.5%-2.7% at year 4) (P<.001 for each). Among ILI participants, 9.2% (95% CI, 7.9%-10.4%), 6.4% (95% CI, 5.3%-7.4%), and 3.5% (95% CI, 2.7%-4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%-2.3%] for at least 2 years; 1.3% [95% CI, 0.8%-1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%-0.8%] for 4 years). Conclusions In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest.
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