饮食和运动干预可预防糖尿病前期患者的远期疾病进展和死亡

研究者在《柳叶刀糖尿病与内分泌学杂志》（Lancet Diabetes & Endocrinology） 网络版上报告，一项为期6年的生活方式干预项目发现，饮食、运动或两者联合干预可延缓成人糖尿病的发生发展，对女性后23年具有显著降低死亡率的生存效益。

研究将577例中国成年葡萄糖耐量受损患者随机分配到对照组和干预组，干预组需完成为期6年的饮食、运动或饮食联合运动干预项目。运动项目的重点为增加休闲性身体活动，饮食项目则是指在必要时减少碳水化合物和酒精的摄入以促进减重。

结果显示，在23年的随访期间，干预组的心源性死亡率显著降低，两组分别为11.9%和19.6%，干预组相对风险降低（RRR）41%；两组的全因死亡率分别为28.1%和38.4%，RRR为29%；糖尿病发病率分别为72.6% 和89.9%，RRR为45%。但仅在女性患者中，显示对死亡率的获益具有统计学意义，女性患者中心源性死亡和全因死亡风险分别降低54%和72%，而在男性中则仅分别降低3%和9%。研究者无法确定死亡率的获益主要见于女性患者的原因，经校正男性较高的吸烟率后，未见这一因素对不同性别死亡率差异的影响。

该研究结论为，葡萄糖耐量受损患者进行长期的饮食和运动治疗将有助于延缓成人糖尿病发生和预防远期死亡。

大庆糖尿病预防研究“是首项发现生活方式干预可降低葡萄糖耐量受损患者的糖尿病发病率和死亡率的研究，”中国北京市中日友好医院李光伟教授及其同事认为，“这一结果为对葡萄糖耐量受损患者实施生活方式干预提供了进一步证据” （Lancet Diabetes Endocrinol. 2014 [doi: 10.1016/S2213-8587(14)70057-9]）。

该研究由美国疾病控制与预防中心、世界卫生组织、中日友好医院和大庆第一医院资助。研究者披露无相关利益冲突。

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A 6-year program of diet, exercise, or both helped delay the onset of diabetes in adults, and had significant mortality benefits for women 23 years later, researchers reported online in the Lancet Diabetes & Endocrinology.

The Da Qing Diabetes Prevention Study "is the first to show that lifestyle intervention in people with impaired glucose tolerance can both reduce the incidence of diabetes and decrease mortality," said Dr. Guangwei Li at the China-Japan Friendship Hospital in Beijing and his associates.

The investigators randomized 577 Chinese adults with impaired glucose tolerance to a control group or to a 6-year intervention program consisting of diet, exercise, or both. The exercise program focused on increasing leisure physical activity, while the diet program promoted weight loss when indicated and reduction of carbohydrate and alcohol intake.They added that the results "provide yet further justification to implement lifestyle interventions for people with impaired glucose tolerance" (Lancet Diabetes Endocrinol. 2014 [doi: 10.1016/S2213-8587(14)70057-9]).

At 23-year follow-up, the intervention group had significantly lower rates of cardiovascular mortality, at 11.9% vs. 19.6%, for a relative risk reduction of 41%; all-cause mortality, at 28.1% vs. 38.4%, for a RRR of 29%; and diabetes, at 72.6% vs. 89.9%, yielding a RRR of 45%.

But the mortality benefit was significant only in women, in whom the risk reductions were 54% and 72% for cardiovascular and all-cause death, respectively, compared with just 3% and 9% in men. The researchers said they could not determine why the mortality benefit was seen primarily in women. Controlling for a higher smoking rate in men did not account for the difference, they said.

The U.S. Centers for Disease Control and Prevention, the World Health Organization, the China-Japan Friendship Hospital, and the Da Qing First Hospital funded the study. The investigators reported that they had no competing interests.