生活方式干预策略治疗老年糖尿病：一项随机对照试验。
Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial.
机构信息
Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX.
Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX.
出版信息
Diabetes Care. 2022 Sep 1;45(9):1943-1952. doi: 10.2337/dc22-0338.
OBJECTIVE
Lifestyle intervention is recommended as first-line treatment of diabetes at all ages; however, little is known about the efficacy of lifestyle intervention in older adults with diabetes. We aimed to determine whether lifestyle intervention would improve glycemic control and age-relevant outcomes in older adults with diabetes and comorbidities.
RESEARCH DESIGN AND METHODS
A total of 100 older adults with diabetes were randomly assigned to 1-year intensive lifestyle intervention (ILI) (diet and exercise at a facility transitioned into community-fitness centers and homes) or healthy lifestyle (HL) group. The primary outcome was change in HbA1c. Secondary outcomes included glucoregulation, body composition, physical function, and quality of life. Changes between groups were analyzed with mixed-model repeated-measures ANCOVA following the intention-to-treat principle.
RESULTS
HbA1c improved more in the ILI than the HL group (mean ± SE -0.8 ± 0.1 vs. 0.1 ± 0.1%), associated with improved insulin sensitivity (1.2 ± 0.2 vs. -0.4 ± 0.2) and disposition (26.0 ± 8.9 vs. -13.0 ± 8.4 109 min-1) indices (between-group P < 0.001 to 0.04). Body weight and visceral fat decreased more in the ILI than HL group (-8.4 ± 0.6 vs. -0.3 ± 0.6 kg, P < 0.001, and -261 ± 29 vs. -30 ± 27 cm3, P < 0.001, respectively). Physical Performance Test score increased more in the ILI than HL group (2.9 ± 0.6 vs. -0.1 ± 0.4, P < 0.001) as did VO2peak (2.2 ± 0.3 vs. -1.2 ± 0.2 mL/kg/min, P < 0.001). Strength, gait, and 36-Item Short Form Survey (SF-36) Physical Component Summary score also improved more in the ILI group (all P < 0.001). Total insulin dose decreased in the ILI group by 19.8 ± 4.4 units/day. Adverse events included increased episodes of mild hypoglycemia in the ILI group.
CONCLUSIONS
A lifestyle intervention strategy is highly successful in improving metabolic and functional health of older adults with diabetes.
目的
生活方式干预被推荐为各年龄段糖尿病的一线治疗方法；然而，对于老年糖尿病患者的生活方式干预的疗效知之甚少。我们旨在确定生活方式干预是否会改善老年糖尿病合并症患者的血糖控制和与年龄相关的结局。
研究设计和方法
共纳入 100 例老年糖尿病患者，随机分为 1 年强化生活方式干预（ILI）组（在设施中进行饮食和运动，过渡到社区健身中心和家庭）或健康生活方式（HL）组。主要结局为 HbA1c 的变化。次要结局包括糖调节、身体成分、身体功能和生活质量。根据意向治疗原则，采用混合模型重复测量方差分析分析组间变化。
结果
与 HL 组相比，ILI 组的 HbA1c 改善更明显（平均± SE -0.8±0.1 vs. 0.1±0.1%），与胰岛素敏感性（1.2±0.2 vs. -0.4±0.2）和分布（26.0±8.9 vs. -13.0±8.4 109 min-1）指数改善相关（组间 P<0.001 至 0.04）。与 HL 组相比，ILI 组体重和内脏脂肪减少更多（-8.4±0.6 与-0.3±0.6 kg，P<0.001，-261±29 与-30±27 cm3，P<0.001）。ILI 组的体力活动测试评分增加更明显（2.9±0.6 与-0.1±0.4，P<0.001），VO2peak 也增加更明显（2.2±0.3 与-1.2±0.2 mL/kg/min，P<0.001）。ILI 组的力量、步态和 36 项简短健康调查问卷（SF-36）身体成分综合评分也改善更明显（均 P<0.001）。ILI 组的总胰岛素剂量减少了 19.8±4.4 单位/天。不良事件包括 ILI 组轻度低血糖发作增加。
结论
生活方式干预策略在改善老年糖尿病患者的代谢和身体健康方面非常成功。
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