The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus.
The Look AHEAD Trial: Implications for Lifestyle Intervention in Type 2 Diabetes Mellitus.
复制标题
DOI：
10.1016/j.pcad.2015.04.002
复制
发表时间：
2015-07
影响因子：
9.1
通讯作者：
Lewis CE
中科院分区：
文献类型：
--
作者：
Dutton GR;Lewis CE
考虑到肥胖的一系列不良健康后果，包括2型糖尿病（T2 DM）和心血管疾病（CVD）的风险增加，Look AHEAD试验（N=5，145）进行测试的假设，一个强化的生活方式干预（ILI）减肥将实现显着更大的减少心血管疾病的发病率和死亡率比对照条件的糖尿病支持和教育（DSE）在T2 DM患者中。观察到ILI有许多显着和长期的改善，包括体重、身体素质和身体功能、血糖控制、生活质量（QoL）和医疗保健费用。然而，ILI并没有显著降低CVD相关的发病率/死亡率（即，CVD死亡、非致死性MI、非致死性卒中、住院心绞痛）。基于基线时的既往CVD病史，提示缓解存在异质性（p=0.06）。尽管总体上缺乏CVD风险降低，ILI对于T2 DM患者的护理仍然很重要，特别是在伴随药物管理时。特别是，ILI可能是希望尽量减少药物强化的患者的一个有吸引力的选择。此外，ILI还具有对患者重要的其他潜在益处（例如，改善身体功能和生活质量）。根据其他试验的数据，强化药物管理，如严格的血糖控制，并非没有潜在风险，在做出治疗决定时应加以权衡。需要进一步研究以确定本试验中观察到的结果是否可在年轻患者、未确诊T2 DM患者和/或无既存CVD患者中复制。
Given the array of adverse health consequences of obesity, including increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), the Look AHEAD trial (N=5,145) was conducted to test the hypothesis that an intensive lifestyle intervention (ILI) for weight loss would achieve significantly greater reductions in CVD morbidity and mortality than a control condition of diabetes support and education (DSE) among participants with T2DM. A number of significant and long-term improvements were observed for ILI, including body weight, physical fitness and physical function, glucose control, quality-of-life (QoL), and healthcare costs. However, ILI did not significantly reduce CVD-related morbidity/mortality (i.e., CVD death, non-fatal MI, non-fatal stroke, hospitalized angina) after nearly 10 years of follow-up. There was a suggestion of heterogeneity of response based on the history of prior CVD at baseline (p=0.06). Despite the overall lack of CVD risk reduction, ILI remains important for care of patients with T2DM, particularly when accompanied by medication management. In particular, ILI may be an appealing option for patients wanting to minimize medication intensification. Also, ILI carries with it other potential benefits important to patients (e.g., improvements in physical functioning and QoL). Based on data from other trials, intensive medication management, such as tight glycemic control, is not without potential risks, which should be weighed in making treatment decisions. Future research is needed to determine if results observed in this trial would be replicated among younger patients, those without established T2DM, and/or those with no pre-existing CVD.