Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance
Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance
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DOI：
10.3109/07853899608999106
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发表时间：
1996-10-01
影响因子：
4.4
通讯作者：
Uusitupa, MIJ
中科院分区：
文献类型：
--
作者：
Uusitupa, MIJ
非胰岛素依赖型糖尿病（NIDDM）在表现为明显的高血糖症之前，会出现持续数年的葡萄糖耐量受损（IGT）。遗传因素和环境因素共同参与IGT和NIDDM的发生发展。肥胖、缺乏运动和高脂饮食是IGT和NIDDM的预测因素。因此，从NIDDM的诊断开始就进行饮食和运动干预，可以改善NIDDM患者的治疗效果和预后。此外，由于IGT受试者患糖尿病和动脉粥样硬化性血管疾病的风险增加，因此可以合理地假设，在降低NIDDM的发病率和长期后果方面，在该阶段进行干预比显性糖尿病更有效。尽管非药物治疗方法被普遍接受为NIDDM的一线治疗方法，但其疗效经常受到质疑。因此，重要的是进行长期对照研究，以了解生活方式的改变在多大程度上可以改善代谢控制和已知与NIDDM不良结局相关的主要心血管危险因素的水平。这类研究也为NIDDM的一级预防研究提供了相关经验。在芬兰库奥皮奥，对新诊断的NIDDM患者进行为期一年的饮食和运动干预，与常规治疗组相比，代谢控制更好，心血管危险因素适度减少。第二年随访后，干预组中只有12.5%的患者接受口服降糖药物，而常规治疗组为34.8%。体重减轻和减少饱和脂肪的使用似乎是成功治疗结果的主要决定因素。良好的有氧能力与高密度脂蛋白胆固醇的增加有关。芬兰正在继续对糖耐量低减患者进行多中心一级预防研究，采用的干预原则与对新诊断的非胰岛素依赖型糖尿病患者进行的研究相同。初步结果表明，葡萄糖耐量可以通过改变生活方式来改善。
Non-insulin-dependent diabetes mellitus (NIDDM) is preceded by impaired glucose tolerance (IGT) lasting for years before manifesting as overt hyperglycaemia. Both genetic and environmental factors contribute to the development of IGT and NIDDM. Obesity, physical inactivity and high-fat diet have been found to predict IGT and NIDDM. Therefore, a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM. Furthermore, because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular diseases, it is reasonable to assume that in terms of reducing the incidence and long-term consequences of NIDDM an intervention at this phase is more effective than in overt diabetes. Although the nonpharmacological approach is generally accepted as the first-line treatment for NIDDM its efficacy has often been questioned. Therefore, it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM. This kind of study also gave relevant experience in planning studies aiming at primary prevention of NIDDM. One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio, Finland resulted in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group, After the second year of follow-up only 12.5% in the intervention group were receiving oral antidiabetic drugs vs. 34.8% in the conventional treatment group. Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results. Good aerobic capacity was associated with an increase in HDL cholesterol. A multicentre primary prevention study on IGT patients is continuing in Finland applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients. Pilot results show that glucose tolerance can be improved by lifestyle changes.