JAMA：强化减肥干预或可部分缓解2型糖尿病

通过生活方式干预而达到2型糖尿病的缓解率有多大，迄今尚不清晰。为了评估长期强化减肥干预与2型糖尿病至糖尿病前期或血糖量正常的缓解率之间的关系，亚特兰大疾病控制与预防中心的Edward W. Gregg, Ph.D.及其同事开展了相关研究。他们的研究结果于2012年12月19日在线刊发于《美国医学会杂志》，显示在体重超重的成年人中，参与强化的生活方式干预（它包括了辅导课程及设定减少热卡摄入及增加身体活动的目标）与II型糖尿病部分缓解的较大的可能性有关，然而，绝对的缓解率则不大。

这个研究的构成是由一个为期4年的随机对照试验（基线随访：2001年8月-2004年4月；最后一次随访：2008年4月）的辅助性的观测分析与一项具有糖尿病支持和教育对照情况（DSE）的强化的生活方式干预（ILI）相比较所组成的。这项研究包括了4503位美国的成年人，他们的身体质量指数为25或以上并患有II型糖尿病。

参与者被随机分配接受ILI——它包括了在第二年至第四年中，在第一个6个月中的每周的小组及个别辅导，并接着在第二个6个月中的每月3次辅导以及每月2次的接触和定期的复习小组系列和活动(n = 2241)；或DSE——它每年会提供3次有关饮食、身体活动及社会支持的小组辅导(n = 2262)。ILI所设定的目标是通过减少总体及饱和油脂的摄入将总热卡摄入减少至1天1200卡至1800卡及通过增加体力活动水平至每周175分钟这一目标。为了帮助达到饮食目标，这些人还被分给了液体膳食替代品。

ILI组的参与者与DSE参与者相比，其在第一年（-8.6% vs. -0.7%）和第四年（-4.7% vs. -0.8%）时有了明显的体重减轻，并在第一年（20.6% vs. 5.3 %）和第四年（4.9% vs. -1.5%）时变得身体更加健康。研究人员发现，在所有的研究年份中，ILI组比DSE组的完全缓解率（即不用药物而血糖正常）要更为常见。但是，绝对的缓解率是低下的，其范围从第一年时ILI的1.3% vs. DSE的0.1% 至第四年时ILI的0.7% vs. DSE的0.2%。

研究人员由此得出结论，对所有体重超重的II型糖尿病成年人的分析证实，与强化的生活方式干预有关的疾病的完全缓解—定义为不需用药而血糖正常—是罕见的。然而，部分缓解—定义为在一个特定时期中无须药物治疗而过渡至糖尿病前期或正常的葡萄糖水平——在某些II型糖尿病患者中是一个能够达到的目标。”

doi:10.1001/jama.2012.67929
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Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes

Edward W. Gregg, PhD; Haiying Chen, PhD; Lynne E. Wagenknecht, DrPH; Jeanne M. Clark, MD, MPH; Linda M. Delahanty, MS, RD; John Bantle, MD; Henry J. Pownall, PhD; Karen C. Johnson, MD, MPH; Monika M. Safford, MD; Abbas E. Kitabchi, MD, PhD; F. Xavier Pi-Sunyer, MD; Rena R. Wing, PhD; Alain G. Bertoni, MD, MPH; for the Look AHEAD Research Group

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 A1c <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.