CDS2018:大庆糖尿病预防30年随访研究揭示生活方式干预降低中国成人IGT患者死亡率

2018-12-02 国际糖尿病编辑部 国际糖尿病

作为全球糖尿病预防领域的里程碑式研究,大庆糖尿病预防研究取得了累累硕果。2018年11月30日,在中华医学会糖尿病学分会第二十二次全国学术会议(CDS2018)的“糖尿病流行病学、卫生经济学及转化医学”专题上,中国医学科学院阜外医院巩秋红教授报告了大庆糖尿病预防30年随访研究结果,揭示了生活方式干预可降低中国成人糖耐量异常(IGT)患者的死亡率。

作为全球糖尿病预防领域的里程碑式研究,大庆糖尿病预防研究取得了累累硕果。2018年11月30日,在中华医学会糖尿病学分会第二十二次全国学术会议(CDS2018)的“糖尿病流行病学、卫生经济学及转化医学”专题上,中国医学科学院阜外医院巩秋红教授报告了大庆糖尿病预防30年随访研究结果,揭示了生活方式干预可降低中国成人糖耐量异常(IGT)患者的死亡率。

大庆研究初步结果:生活方式干预能够显著降低糖尿病发病风险

大庆研究是世界上第一项证明生活方式干预能够预防糖尿病的研究,在1986年对大庆地区的部分人口通过口服葡萄糖耐量试验(OGTT)筛查出IGT患者576例,以小组随机方式分为4组,其中一组为对照组,另外三组为生活方式干预组(饮食、运动、饮食和运动),进行了为期6年的生活方式干预。三组干预均表现出了非常积极的结果,即发现生活方式干预能够显著降低糖尿病发病风险39%。之后,在世界范围内,研究结果先后在芬兰、美国、日本、印度得到了验证。



大庆研究30年随访结果:生活方式干预可预防糖尿病长期并发症

生活方式干预能够预防糖尿病,那么能否进一步预防糖尿病的并发症和降低死亡率?为了回答这个问题,大庆研究分别在2006年和2016年,也就是研究开始的20年和30年,开展了后续随访研究。

2006年,大庆20年随访研究结果发现,6年的生活方式干预在预防糖尿病的同时,能进一步降低IGT人群的糖尿病全因死亡和血管死亡,在世界上第一次证明了生活方式干预可以预防糖尿病的长期并发症,该结果的公布引起了业界轰动。因为大庆研究要早于芬兰糖尿病预防研究(DPS)和美国糖尿病预防计划(DPP)研究8~10年,这些结果在世界范围内尚未得到验证,美国研究者受其启发将DPP研究延长至25年。那么,大庆研究结果是否是一家之言?抑或是一种偶然?此外,在20年的随访结果中并未看到生活方式干预对血管事件的影响存在统计学差异,对于严重影响糖尿病患者生活质量的微血管病变如失明、肾衰竭也需要更长时间来得出结论。此次报告的大庆研究30年结果就是要回答这些问题的一部分。

大庆30年研究结果显示,干预组较对照组的全因死亡风险显著降低。在30年随访中,对照组有56.3%的人死亡,而干预组死亡率为45.5%,对照组风险降低了26%(HR:0.74,95%CI:0.61~0.89,P=0.002)。在女性中,死亡风险下降41%(HR:0.59,95%CI:0.38~0.91,P=0.04)。大庆研究随访30年后,35.2%的对照组和25.6%的干预组死于心血管疾病,与对照组相比,干预组使心血管死亡率下降33%(HR:0.67,95%CI:0.48~0.94,P=0.02)。这些结果都与20年研究结果相一致,证明了生活方式干预可持续(长达30年)降低全因死亡和心血管死亡风险。

该研究还发现,全因死亡的NNT(number needed to treat),即需要预防人数为10例(95%CI:6~25,P=0.002)。也就是说,生活方式干预10例IGT患者6年,在30年时就可预防1例患者死亡。







研究意义

目前,中国糖尿病患病率日益增高,已成为世界糖尿病第一大国,给国家带来沉重的经济和社会负担,严重影响个人生活质量和寿命。大庆糖尿病预防后续随访研究证明,生活方式干预简单易行,花费低,效果持久,为世界各国尤其是发展中国家制定慢病防控策略增加了有利依据。

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    2019-10-12 habb
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    2018-12-04 爆笑小医
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    2018-12-02 haige

    大庆研究证明:生活方式干预简单易行,花费低,效果持久。

    0

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    2018-12-02 misszhang

    谢谢MedSci提供最新的资讯

    0

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