论文部分内容阅读
背景2型糖尿病成人患者常随年龄增长而出现活动受限。强化生活方式干预能够减轻体质量、改善健康,可减慢此类患者活动度下降的过程。方法将患有2型糖尿病的超重或肥胖患者5 145人(年龄45～74岁)随机分为强化生活方式干预组及糖尿病支持和教育组。5 016例参试者归入研究数据。采用隐马可夫模式描述失能状态,混合效应序列逻辑回归分析评价功能减退可能性。主要结局是自我报告的活动受限,每年评估1次,共开展4年。结果到第4年,在生活方式干预组2 514例成人中,严重失能517例(20.6%),活动度良好969例(38.5%);在支持和教育组2 502例成人中,相应的人数分别为656例(26.2%)和798例(31.9%)。与支持和教育组相比,生活方式干预组活动度受损风险相对降低48%〔OR=0.52;95%CI(0.44,0.63);P<0.001〕。体质量减轻及健康改善(用踏车试验做评估)是达到这一效果的重要成因(两种变量均为P<0.001)。与生活方式干预相关的不良事件包括在第1年时略高的肌肉骨骼症状发生率。结论对于患有2型糖尿病的超重成人,减轻体质量和改善健康可减慢活动度下降过程。
Background Adult patients with type 2 diabetes often have limited mobility as they age. Intensifying life style interventions can reduce body mass, improve health and slow down the decline in activity of these patients. Methods A total of 5 145 overweight or obese patients (aged 45-74 years) with type 2 diabetes were randomly divided into intensive lifestyle intervention group and diabetes support and education group. 5 016 participants were included in the study data. Hidden Markov model was used to describe the incapacitating condition, and mixed effect sequence logistic regression analysis was used to evaluate the possibility of functional decline. The main outcome is the limited self-reported activity, which is assessed once a year for a total of four years. Results In the fourth year, among 2 514 adults in the lifestyle intervention group, 517 (20.6%) were seriously disability and 969 (38.5%) were well disabled; among the 2 502 adults in the support and education group, the corresponding The numbers were 656 (26.2%) and 798 (31.9%), respectively. Compared with the support and education groups, the risk of impairment of activity in the lifestyle intervention group was reduced by 48% (OR = 0.52; 95% CI, 0.44, 0.63; P <0.001). Weight loss and health improvement (assessed by treadmill testing) were important contributors to this effect (both P <0.001). Adverse events associated with lifestyle intervention included slightly higher rates of musculoskeletal symptoms at year 1. Conclusions For overweight adults with type 2 diabetes, reducing body weight and improving well-being may slow down the activity decline.